Changes coming in 2021 2020 looks to be a transition year on the payment front, as many programs and changes expected to go into effect this year have been delayed until 2021. These include new CMS-created primary care models and a streamlining of evaluation and management level-of-care coding. CMS announced in October its newest alternative […]
Two metrics important to the discussion of creating claims most likely to be immediately reimbursable are Clean Claim Rate (CCR) and First Pass Rate (FPR). Though sometimes confused for one another, these are separate statistics, each worthy of optimization. HFMA identifies the value of CCR as an indicator of the quality of data collected and reported. […]
Read this report from the Advisory Board on ways you can improve revenue cycle performance now. Hospitals leaving $22M on the table
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.
Click to access PNC%20SW%20Ohio%20HFMA%20Presentation.pdf Using KPIs to Accelerate Revenue Cycle Performance Click to access PNC%20SW%20Ohio%20HFMA%20Presentation.pdf Measurement • We’ve all heard it: you can’t manage what you don’t measure. – Measurement aids in identifying problem areas. – Sets the stage for setting goals/targets and working toward them. • It is also a proven principle that: – […]
Infrastructure Establish a multidisciplinary team to serve as the Denial Management Task Force. This team should include Patient Accounting, Patient Access, Case Management, Denial Management or Revenue Integrity, HIM, Information Technology, and the vendor, if one is utilized. The executive sponsor should be someone at the Vice President level, such as the Chief Financial Officer […]
Overview of Denials management with case studies on overturning denials. Denials Management overview and Managed Care_Denial Management