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How well are Statutory Documentation Requirements Decreasing CMS Program Risks?
The Government Accountability Office (GAO) issued a report on March 27, 2019, stating CMS should assess documentation necessary to identify improper payments. The study was performed on Medicare FFS and Medicaid FFS improper payment data for four selected services...
Coding Denials: Four Trends and Six Tips from Journal of AHIMA
The Journal of AHIMA’s March 2019 issue included an important article regarding recent upticks in commercial payer denials—specifically coding denials. Co-authored with Yale New Haven Health, the article encourages AHIMA members to build knowledge, awareness and...
Day 11: Our Experts are Piping Up About Next Year
Publication: Answers Media Network - HITECH Answers "Its been 10 years since the Recovery Audit Contractors rocked hospital providers world with a record number of audits and overpayment determinations."
Talking Payer Denials and Appeals on HealthcareNOW Radio
Earlier this month, Brian McGraw had the opportunity to talk with the host of InterviewsNOW, Shereese Maynard, from HealthcareNOW Radio about payer denials and appeals. Listen to the full interview with McGraw and Maynard:
How Less Than a Half of an Inch Cost a Hospital > $1,700 in Denied Payment
by Denise Wilson, RN, MS, RRT, Vice President, Clinical Appeal Services, Intersect Healthcare Reproduced with permission of ACPA A large national insurance carrier, offering managed Medicaid plans, recently denied the inclusion of ICD-10-CM codes Z68.41, body mass...
CMS Audits Highlight MAO Performance Problems Related to Denials
By R. Kendall Smith, Jr., MD, SFHM A report released by the HHS Office of Inspector General (OIG) in September 2018 found that Medicare Advantage Organizations (MAOs) overturned a jaw-dropping 75 percent of their own denials from 2014 to 2016. Even more startling was...
Regulatory Waivers, EMTALA Exemptions Effective During Hurricane Harvey
Permission to reproduce granted by RACmonitor By Denise Wilson, RN, MS, RRT EDITOR’S NOTE: With Hurricane Irma expected to impact Miami-County today, this story, updated from a news alert posted last week on the ICD10monitor website, offers lessons learned for...
The Missing Wheel on the Revenue Cycle
Practical steps to reduce insurance denials and steadily improve the bottom line By Kendall Smith, MD | Chief Physician Advisor to the Intersect Healthcare Leadership Team I was writing an appeal for a hospital system the other day to a large insurer. It was one of...
Appealing Medicare Advantage Denials For Patients Gives Hospitals More Leverage
Reprinted with permission by the Report on Medicare Compliance Fed up with claim denials for inpatient admissions by Medicare Advantage (MA) plans months after they were approved, Self Regional Healthcare in Greenwood, S.C., complained to the CMS regional office in...
Why You Should Include Payer Payment Guidelines in Appeal Templates
Including payer payment guidelines in your appeal letter templates can increase the efficiency and effectiveness of your appeal writing. Most payers develop and publish very specific payment guidelines for medical and surgical procedures. This ensures payment is made...
The Use of Evidence Based Medicine in Appeal Letter Templates
Insurance company denials of payment are rarely issued in a random and infrequent manner. Most denials for services rendered are grouped around specific issues on payment policies, as defined by the insurance carrier. As an appeal writer, it only makes sense to...