Healthcare Auditing involves more than just validating data. It also includes understanding the coding, charging and billing rules, as well as Regulatory Guidance, around the services being audited.
OIG audit identifies that CMS failed to collect more than $200 million in overpayments.
The future of hospital and revenue integrity advocacy. See a NAHRI (National Association of Healthcare Revenue Integrity) Q&A that addresses this topic.
More patients are bringing their drugs with them to the hospital for various reasons. What does CMS say about reporting these drugs on the claim?
Prevention is better than a cure, but thatís often easier said than done when it comes to denials. The challenge is two-fold: disagreements about accountability and responsibility and a lack of comprehensive data to understand root causes and trends early enough to act. These are complex problems that require organization-wide commitmentóbut the payoff more than makes the case.
Medicare pays specific Part B physician or practitioner services provided through a telecommunications system. Telehealth services substitute for an in-person visit.
Transplant billing rules can be complex. See a NAHRI Q&A that addresses this topic.