Preventing Medical Necessity Denials KAREN HOPPE Although all hospitals must comply with a Medicare requirement that services provided to beneficiaries are reasonable and medically necessary for treatment and diagnosis, the criteria may be inconsistent among the agencies setting them. The Centers for Medicare & Medicaid Services (CMS) created policies that dictate the criteria that […]
NCDs (National Coverage Determinations) and LCDs (Local Coverage Determinations) are decisions by Medicare and their administrative contractors that provide coverage information and determine whether services are reasonable and necessary on certain services offered by participating providers.
KPI’s from HFMA MAP Keys program MAP Keys are industry-standard metrics or KPIs usedto track your organization’s revenue cycle performance usingobjective, consistent calculations. http://www.hfma.org/MAP/mapkeys/ map-award-tables_061616-2
Enterprise Resource planning Enterprise resource planning (ERP) is an industry term for the broad set of activities that helps an organization manage its business. An important goal oF ERP is to facilitate the flow of information so business decisions can be data-driven. ERP software suites are built to collect and organize data from various […]
Resource -Based RVU defined July 01, 2014 Linked Articles The Basics of Making RVUs Work for Your Medical Practice RVUs Remain a Relevant System to Determine Physician Compensation Assigning RVU Values to Procedures That Don’t Have Them Using RVUs to Measure Physician Performance Calculate Your RVU Payment Cost Accounting in the Medical Practice via RVU […]
http://thehappyhospitalist.blogspot.com/p/free-evaluation-and-management-hospital.html Lectures on E&M levels of Hospital procedures
http://emuniversity.com/Level3EstablishedOfficePatient.html Great info on tracking cpt codes for billing. Gives you the Level of visit. Easy to understand.
The Right Questions to Diagnose Physician Practice Financial Pains Article taken from HFMA.org website http://www.hfma.org/Content.aspx?id=29597#.V55d8M-ISxo.email Major themes 1) Do You Know What Your Payers Are Paying? For example, I once talked to an orthopedic group that was being underpaid for a common injection they billed for quite often, which resulted in a loss of hundreds […]
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/RuralChart.pdf https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c13.pdf https://www.cms.gov/center/provider-type/rural-health-clinics-center.html