Reimbursement

Webinar Replay - Auditing Your Interventional Radiology Reports to Insure Complete and Compliant Reimbursement

CPT coding for Interventional Radiology (IR) services has always been viewed as one of the more complex services lines to master, let alone understand!  Component coding, complete procedure coding “hybrid” bundled coding—all techniques and options are in play.  As a professional responsible for assigning the CPT codes for these services, what are best practices?  Pitfalls?  How should documentation be structured?

Claims Adjudication and Payer Rules under ICD-10

Rayellen Kishbach's picture

Because we process thousands of LCDs updates weekly for our Coding Suite, we often get some insights that we can share. With the implementation of ICD-10, a significant drop off in the number of local coverage determinations (LCDs) and coverage articles published by the Medicare Administrative Contractors (MACs) has occurred. (See table in the white paper link below). While this may be partly due to MAC consolidation, it has left providers with less guidance than before about the proper coding and billing of covered services.

How health care economics teams communicate with payers (and other healthcare entities)

Rayellen Kishbach's picture

In January 2017, the FDA released draft guidance specifying the nature of communications between manufacturers and payers: The first draft guidance, entitled “Drug and Device Manufacturer Communications with Payers, Formulary Committees, and Similar Entities--Questions and Answers,” provides answers to common questions regarding communications of health care economic information (HCEI) about their approved prescription drugs to payers.

Webinar Replay - Chargemaster Management & Data Integrity

As a living document, the chargemaster should be updated at a minimum on a quarterly basis, but there is need for daily changes: departments add and remove charges, payers update contracts, and a regulatory environment in flux demands constant updates. Healthcare organizations know they can improve the integrity of their revenue programs through ongoing review and maintenance of their chargemaster, but many struggle with best practices in the face of complexity.

Webinar Replay- Understanding Coding, Coverage and Payment rules for Spinal Procedures

Payers have tightened restrictions on coverage requirements for spinal fusion procedures. The prior-authorization process has gotten more specific, down to the specific device. Denials are up for the whole procedure if the device is non-covered.

Join Patty Telgener RN, MBA as she reviews the changing coverage landscape for spinal cord stimulation procedures and devices, new thinking about efficacy for spinal fusion procedures, coding and payment for spinal procedures under Medicare, IPPS, OPPS and ASC systems, as well as regulatory changes and audit activity.

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