Following the recent unveiling by federal officials of the 2021 Outpatient Prospective Payment System (OPPS) Final Rule, Panacea Healthcare Solutions has created a comprehensive Final Rule Summary highlighting some of the most salient looming changes facing healthcare providers nationwide.
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Our revenue integrity team continually monitors announcements by the Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) to bring you the most current and up-to-date coding and billing information. Since our last quarterly update, CMS and AMA have been actively publishing new information that hospitals and providers will need to […]
Have you ever wondered how hospital prices became so irrational? As is often the case, things changed incrementally. Hospitals and healthcare systems…
Over the last several months we’ve seen an uptick in requests from clients nationwide for help reconciling laboratory orderables to chargemasters. In case you’re in this same boat, we wanted to provide some insight into the steps you should be taking.
With the CMS Final Rule published there is a flurry of activity across the industry to come up to speed on the changes. In our experience though we’ve found that for many healthcare systems it’s easier to keep track of changes to the codes, rules, and guidelines they are already using; the challenge comes in becoming aware of and implementing when new things are introduced.
On January 1, 2019 the Hospital Price Transparency Rule took effect mandating hospitals publish their price lists online in a machine-readable format. Hospitals complied by making their charge description master (CDM) available via download in CSV or similar format. The result fell far short of CMS’ goal of empowering patients to become “active healthcare consumers” and the agency on July 29, 2019, in response to the Trump administration Executive Order on Price and Quality Transparency, proposed expanded rules aimed at more “consumer friendly” transparency.
We’ve summarized the Centers for Medicare and Medicaid Services (CMS) and American Medical Association (AMA) payment and coding updates being implemented October 1, 2019. The updates should be reviewed for possible implementation in your hospital chargemaster and/or reviewed by applicable coding and billing staff.
As laboratory services are one of the highest revenue-producing departments in most health systems, it’s incredibly important to bill these services correctly. However, it’s also an area fraught with lots of guidelines and restrictions—and with many staff members throughout the hospital system working laboratory accounts, there is a high risk of errors and inconsistencies. This is a situation we’ve seen and helped correct in health systems nationwide.
Is your revenue integrity program performing at full capacity?
Perhaps more important, do you have a revenue integrity program (or department) at all?
A survey conducted by the Healthcare Financial Management Association (HFMA) reports that less than half (44%) of providers contacted have a revenue integrity department to track accurate coding and charge capture, establish reasonable pricing for services, ensure legal and regulatory compliance, and develop effective financial reporting. Yet those that have established revenue integrity programs have realized an overall increase in net revenue.
Panacea announces enhanced Pharmacy Revenue Improvement solution, which combines expert consultants…