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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...
read moreSeven strategies to build an effective appeal process
Facility appeal writers must craft piles of appeals, with virtually no time to investigate the accuracy of payer denials. However, understanding the appeal process is crucial. Engaging a physician advisor can bring the knowledge and experience of a physician to the...
read moreCoding 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...
read moreAppealing Clinical Validation Denials in the Era of Sepsis-3
by Denise Wilson MS, RN, RRT, Vice President of Clinical Audit and Appeal Services, Intersect HealthcareReproduced with permission of ICD10 MonitorDenise Wilson MS, RN, RRTVice President of Clinical Audit and Appeal Services, Intersect HealthcareHigher overturn rates...
read moreTalking Payer Denials and Appeals on HealthcareNOW Radio
Earlier this month, Co-founder, President & CEO, 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:
read moreLooking to 2019: Our Experts Weigh In
by Dawn Crump, Senior Director, Revenue Cycle and Denial Management Solutions, Intersect Healthcare Reproduced with permission of RCM Answers Dawn Crump Senior Director, Revenue Cycle and Denial Management Solutions, Intersect Healthcare Twitter: @IntersectAppeal Its...
read moreHow 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...
read moreCMS 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...
read moreProvider Provisions under Managed Care Contracts—What CFOs Need to Know
Managed care contractual provisions affect payment, departmental organization, billing procedures and confidential records. Contracts can also impact clinical decision-making. They are a formidable force to be considered by healthcare executives at every step in the...
read moreRegulatory 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...
read moreThe 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...
read moreAppealing 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...
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