The Crucial Role of Medical Coding Compliance in a Value-Based World: Telling the Patient’s Story for Better Billing and Quality Care. Medical Coders: The Unsung Storytellers of Healthcare Medical coders play a critical role in hospitals, but their importance often goes unnoticed. They’re the storytellers behind the scenes, analyzing patient records, selecting billing codes, and […]
In this article, we discuss the benefits of coding and case management (CM) collaboration – in particular, the value of CM documentation. By no means is this going to be an article about how case management should be cross-trained to learn coding. However, we believe there is value in coding professionals being able to engage […]
Waiving the PAYGO sequester requirements and updating the 2023 Medicare Physician Fee Schedule would help limit Medicare payment cuts to hospitals, FAH wrote. As the 117th Congress nears the end of its session, the Federation of American Hospitals (FAH) has called upon congressional leaders to pass legislation that will reduce financial challenges for hospitals, including […]
The proposed outpatient payment updates for 2023, including the 2.7 percent reimbursement increase, do not reflect the inflationary environment in which hospitals are operating. When commenting on the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System proposed rule for calendar year (CY) 2023, the American Hospital Association (AHA) supported […]
COVID-19 hospitalization costs varied by state, with the highest in-network cost averaging $128,650. According to a new FAIR Health study, COVID-19 hospitalization cost varies by state, with complex hospitalizations for COVID-19 in-network average cost maxing out at $128,650. “Behind the numbers of our COVID-19 Cost Tracker are the individuals who have contracted COVID-19. As a […]
Anthem Blue Cross, the country’s second-biggest health insurance company, is behind on billions of dollars in payments owed to hospitals and doctors because of onerous new reimbursement rules, computer problems and mishandled claims, say hospital officials in multiple states. Anthem, like other big insurers, is using the COVID-19 crisis as cover to institute “egregious” policies […]
On Aug. 2, 2021, the Centers for Medicare and Medicaid Services (CMS) posted the fiscal year (FY) 2022 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) final rule. Effective Oct. 1, the final rule updates Medicare payment policies and quality reporting programs for inpatient and long-term care hospitals […]
Hospital groups are digesting the 863-page CY 2022 OPPS proposed rule, but many are already commenting on new hospital price transparency penalties and other policies. The newly proposed Medicare Outpatient Prospective Payment System (OPPS) rule for calendar year (CY) 2022 is causing a stir with new hospital price transparency enforcement rules and other policies. The […]
The pandemic has only made the trend worse, as 33% of hospital executives report average claims denial rates of 10% or more. Hospital claim denial rates have hit new highs, with a 20% increase in those rates over the past five years, suggesting that better claims denial management processes are necessary, finds a new […]
After COVID-19 disrupted the healthcare system last year, finance teams adjusted processes to provide budget flexibility and rolling forecasts and will continue to do so in 2021, according to Syntellis Performance Solutions’ 2021 Healthcare Financial Trends Survey report. Compared to 2019, 59 percent more respondents expressed confidence in their team’s capacity to quickly adjust finance […]