by Denise Wilson, RN, MS, RRT, and Karla Hiravi, RN, BSN
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.Read More »
As part of the eighth annual Clinical Documentation Improvement Week, ACDIS has conducted a series of interviews with CDI professionals on a variety of emerging industry topics. Mindy Davis, RHIT, CDIP, CCS, director of HIM and CDI at Rutherford (North Carolina) Regional Health System in...Read More »
By Trey La Charité, MD, FACP, SFHM, CCDS
Over the years, Congress passed numerous pieces of legislation to limit healthcare spending, combat losses due to fraud, and ensure that dollars spent truly benefit the American population with quality care. Numerous watchdog programs...Read More »
According to a recent report from the RAND Corporation, public rankings of hospital quality would be more accurate and useful if they incorporated the different ways patients judge a hospital’s performance.Read More »
In a ruling, a U.S. district judge sided with UnitedHealth, which argued that the rule requiring MA plans to return overpayments based on an analysist of its members...Read More »
Along with quality measure removals in the 2018 OPPS and MPFS final rules, CMS continues to propose additional removals in its proposals for 2019 and it wants greater flexibility to remove quality measures in the future.Read More »
Last week, CMS released a report on the first-year performance of the agency’s Next Generation ACO model. For the 2016 performance year, the model generated net savings for Medicare of about $62 million while...Read More »
Q:We are receiving denials on the grounds that encephalopathy must be resolved prior to discharge in order to be present. How would you suggest we fight these denials?Read More »
