Expert Opinions

Recommendations to Providers on Price Transparency Priorities to Address Now

Read Unpacking CMS’ 2020 Proposed Expanded Rules for Hospital Price Transparency to gain a better understanding of the Proposed Rules for Hospital Price Transparency released by CMS on July 29, 2019. The comment period ended September 27, 2019, and the final rule is forthcoming. After review of public comments on the proposed Hospital Price Transparency […]

Summary of the Centers for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA) payment and coding updates for Q4′ 2019

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.

Is Your Staff Struggling with How to Bill Lab Services? 4 Steps to Better Results

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 […]

Pricing Transparency is Here. What Now? What next?

On August 2, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that was intended to empower patients through better access to hospital price information.  Current laws already required hospitals to make public a list of their standard charges, but the new requirement which became effective on January 1, 2019, required […]

Pricing Strategies. What’s Your Defense?

In today’s era of intense public scrutiny on medical costs, what’s your pricing strategy? Does it pass the test of fairness and accuracy, without sacrificing revenue objectives?

Driving Focused Physician Audits and Education Using Predictive Analytics

Learn a new holistic approach to physician auditing using technology, expertise, and education. With a predictive analyzer tool, you can identify incidents and patterns of potential billing and coding as well as opportunities where under-coding of services may be taking place. The results will drive meaningful focused audits and provider specific education.

The Top 3 Compliance and Auditing Mistakes and How to Avoid Them

In today’s environment of increasing regulatory oversight and ever-changing reimbursement policies, compliance must be more than a checkbox. Though an annual compliance and audit plan is not legally mandated, there are few healthcare organizations that don’t have compliance on their radars. However, if your compliance focus is simply to check a box, you’re missing out.

CMS Price Transparency Requirement: Six Steps Towards Ensuring Compliance and Defensible & Rational Pricing

The CMS 2019 transparency requirement underscores their ongoing initiative and emphasis on empowering patients through better access to hospital charge information.

It’s a Fact: Revenue Integrity Programs Increase Net Revenue

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 […]

Does your organization have a strategic plan to address CMS FY19 IPPS proposed rule that requires hospitals “to make public their standard charges via the Internet?”

Written By: Fred Stodolak, Executive Vice President, Mark Spehar, Senior Vice President, Financial Services, Henry Gutierrez, Vice President, Financial Services There is an increasing debate surrounding CMS FY2019 IPPS proposed rule, published April 24, that would require hospitals “to make public a list of their standard charges via the internet.” Discussions around this topic have […]