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 hospitals to publish a list of all charges in machine readable format via the internet, in an XML or CSV format. The final rule also required providers to update their posted charges no less than one time per year.
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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.
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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.
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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.
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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 pointed out a number of valid arguments:
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By training coders who already are on staff, hospitals leverage institutional knowledge and build career paths.
Changes in payment policies, laws, and regulatory oversight are forcing healthcare organizations to respond to increased regulatory scrutiny and audits. Medicare audits have increased by 936 percent in the past five years*. Ad hoc inpatient audits are no longer enough of a defensive strategy. Robust internal auditing programs are becoming a must for inpatient organizations.
We had a great time at HCCA’s Compliance Institute conference in Las Vegas and enjoyed meeting everyone. It’s always so exciting to see all of the strategies and methods professionals across the healthcare industry are using to accomplish their diverse goals.
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In 1992, CPT coding options for interventional radiology (IR) procedures underwent a seismic shift in “how” to code. Gone was the old method of complete procedure codes (a one-size-fits-all code); the new method added separate options to describe “what was done” and “where or how you did it.”