Creating a sustainable revenue cycle occurs with the interaction of a number of important functions, people, and processes, all of which must work in tandem.
Clinical documentation improvement is a provider’s best defense against payment denials, audits, and preserving revenue integrity—which is why the people sitting in the C-suite should know what it is and prioritize it.
There is rare bipartisan momentum in support of several different pieces of legislation aimed at addressing the issue of “surprise medical bills”— exorbitantly high emergency and other medical department bills.
The American Medical Association and United Healthcare have proposed more than 20 new ICD-10 codes for social determinants of healthcare that identify social diagnoses or barriers to healthcare. The proposed expanded codes “would capture these social diagnoses and barrier situations to assist providers and consumers in obtaining routine care, medications, and preventive services that are not captured today, thereby benefiting the industry as a whole in the management of patient care,” states the United Healthcare and AMA proposal in a document made available by the CDC.
With the biggest reimbursement system change for skilled nursing facilities (SNFs) in 20 years approaching, the American Health Information Management Association (AHIMA) and the American Health Care Association (AHCA) partnered up to ensure SNFs were ready.
The rising volume of requests from payers heightens the burden on HIM to handle the associated release of information demands. Following three strategies can help HIM departments better control the surge in payer requests.