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This Dec. 10 webinar explains how Billings Clinic bridged gaps between pharmacy expense data and financial system to ensure proper pricing and billing.
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There are many factors to consider when evaluating the need for a RAC coordinator. Primary to the decision is the actual volume of requests and dollar amount of revenue at risk.
Section 340B of the Public Health Service Act establishes a program under which certain hospitals may obtain significant discounts on drugs furnished to outpatients.
There has been some debate regarding which patients are entitled to drug discounts under the 340B program.
To meet the challenges presented by recovery audit contractors (RACs), hospitals should perform six tasks that require appropriate investments in staff.
Healthcare providers cannot afford to delay their detailed meaningful use planning.
Outpatient care presents special RAC-related risk, but several steps can mitigate that risk.
To prepare for a RAC audit, Yale New Haven Hospital has developed a RAC readiness team, created an efficient workflow design, and implemented a new software solution.
Challenges include changes to the inpatient prospective payment system, RACs, ICD-10, and pay for performance.
Tracking RAC chart requests is just one of the things that can help you survive these audits.
To date, healthcare organizations in only a few states have experienced the financial impact of the RAC program, but soon, the program's reach will span the United States.
With the focus on bad debt increasing, it is important to understand CMS's stance on this issue.
Despite a 28 percent rise in the average cost of uncompensated care over five years, hospitals have thus far been able to maintain their margins.
The demonstrations are over. This year, the Centers for Medicare & Medicaid Services (CMS) is rolling out its Recovery Audit Contractor (RAC) program nationwide.
As the legislative process for healthcare reform unfolds, proposed new payment structures, delivery mechanisms, and regulatory developments may change the way hospitals and physicians interact in a new healthcare market.
The ability of a hospital to share with physicians cost savings generated in part by physicians' efforts has long been stymied by a law imposing civil money penalties on hospitals that pay physicians to limit care to Medicare beneficiaries.
There are four key strategies for reducing a provider’s audit risk, with corresponding action steps for each strategy.
Publicly available data from Medicare can help hospitals benchmark their experience against the experiences of their peers to identify unexpected variations and opportunities for improvement.
There are a number of legal issues that the move to accountable care raises for hospitals.
An analysis of a set of Medicare RAC appeal decisions rendered by administrative law judges suggests ways that CMS might improve the process.
The successful development of ACOs would permit CMS to contract directly with providers in much the same way the agency contracts with insurers under Medicare Advantage.
A successful ACO strategy starts with clearly articulating a patient-centered strategic plan that supports organizational goals.
To assess the risk posed by improper billing, coding, and pricing for pharmacy items, hospital finance leaders should perform an audit of the pharmacy department's charge description master.
This fact sheet provides a quick look at the Medicare and Medicaid EHR incentive programs.
There are four key steps providers can take to position themselves for a RAC audit.
As hospitals prepare for a new world of shared payments under the ACO model, they need to make determinations with respect to four key areas of concern: integration, cost versus benefits, patient loyalty, and risks versus rewards.
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