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EHR upgrades are pain point for rev cycle execs, new survey shows

12/31/2018

The struggle to keep up with electronic health record (EHR) upgrades is an area of concern for revenue cycle professionals, finds a Navigant/Healthcare Financial Management Association analysis.

Watch for upcoming HHS agenda items that may mean changes for HIPAA

12/31/2018

by: Heidi Samuelson

HHS’ semiannual agenda, published in October, included a request for information (RFI) on provisions of HIPAA that may be stalling progress toward increasing coordinated care and case management among hospitals, physicians, payers and patients, and impeding the transformation to value-based payment systems.

Note from the instructor: How to perform a technical evaluation of denials

12/31/2018

by: Linda M. Huckin, RN BSN, ACM, CPC, CDEO, CIC

A denial represents the health care insurance company’s decision not to adjudicate the claim because of a conflict over service, payment or coverage. Starting from this perspective, the appeal strategy must begin with identifying the payer. Next, determine whether the health care insurance is classified and managed as a commercial or government payer and whether the provider’s organization is a contracted or non-contracted entity.

How to effectively document and bill chronic care management

12/31/2018

by: Nena Scott, MSEd, RHIA, CCS, CCS-P, CCDS

Within the past two years, Medicare began issuing a separate payment for chronic care management (CCM) services under CPT code 99490. In 2017, CMS issued new guidelines to provide greater specifications and updated details to improve CCM documentation and billing. This article provides guidance on correct coding, billing and documentation for chronic care conditions in health care as defined by CMS and effective in 2018.

Get definite about definitive drug tests to avoid the attention of auditors

12/31/2018

by: Julia Kyles, CPC

Practices that report definitive drug tests continue to struggle with high denial rates, the latest Medicare Part B billing data for the tests shows. Because CMS has worked to curb improper reporting of the services, continued high denials may trigger audits and other intrusive measures. If investigators get involved, they could use strong-arm methods to wring large settlements out of practices.

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