Coding

In new final rule, CMS looks to claw back billions in overpayments to Medicare Advantage health plans

CMS has confirmed a new approach to its auditing of payments directed to Medicare Advantage health plans, but the agency says the regulatory burden on providers should not increase. A newly published final rule on risk adjustment data validation (RADV) establishes that CMS will use an extrapolation methodology to recoup overpayments to MA plans beginning…

Nick Hut February 3, 2023

News Briefs: Financial and operational challenges still hamper hospitals 2.5 years into the pandemic

As published in hfm magazine, a monthly roundup of top news for healthcare finance professionals.

Nick Hut September 29, 2022

Recent changes to E/M coding mean time-based billing could be advantageous for longer visits, study finds

Depending on patient volumes, clinics could benefit from incorporating time-based billing instead of relying on CPT coding approaches.

Nick Hut September 11, 2022

TransUnion’s Transfer DRG solution simplifies the underpayment process

One company reviews how its SaaS solution can simplify identifying transfer DRG underpayments for hospitals.

HFMA August 31, 2022

As revenue cycle challenges accumulate, a new survey suggests hospitals are taking a closer look at automation

For hospitals and health systems, survey results show that the ongoing labor crunch in revenue cycle operations has provided an impetus to expand process automation.

Nick Hut July 29, 2022

Even as costs surge, Medicare physician payments are scheduled to decrease in 2023

Medicare physician payments would decrease by more than 4% in 2023, according to a proposed rule.

Nick Hut July 11, 2022

Digestive diseases led increase in treatment costs over the last two decades, analysis finds

A new study quantifies the extent to which treating disease has become increasingly expensive since just before the turn of the century.

Nick Hut May 30, 2022

Hospitalists are more likely than other physicians to choose high-intensity codes for inpatient care, study finds

The billing and coding practices of hospitalists may contribute to the rising cost of hospital care in the U.S., according to conclusions of a new study.

Nick Hut May 18, 2022

Some Medicare payments to hospitals for bariatric surgery may be inappropriate, OIG finds

Medicare could have saved nearly $48 million in bariatric surgery payments to hospitals during an 18-month period if coverage rules and guidance were better implemented at the contractor level, according to the HHS Office of Inspector General.

Nick Hut May 17, 2022

Revenue Cycle Insights: May 2022

No Surprises Act implementation continues. Though arbitration cases are expected to be addressed in a slow fashion at first, there may be some related regulatory changes that favor providers, Nick Hut reports.

HFMA May 11, 2022
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