4 Charge Capture Process Approaches & Reasons for Inaccuracies

Heather Chartier, MS, RHIA, CCA Auditing Leave a Comment

Proper charge capture processes are essential to compliance regulations. An outdated, non-existent, or poorly thought-out charge capture workflow can be devastating to a hospital and healthcare system’s bottom line. Overcharging can be just as harmful as undercharging for medical services. The key to appropriate charge capture processes has shifted from a solely...

5 Pieces of Advice for New H.I.M. Directors

Heather Chartier, MS, RHIA, CCA Revenue Cycle Leave a Comment

Finding purpose through meaningful work has been on the minds of many lately. Purpose, essential to organizational development and the lifeblood of the human heart as it relates to the whole organizational body system, is what makes life meaningful. Often, health care workers enter the health care field because they love to help people and contribute to enhancing a...

Retirement Looms for 3.5 Million Retirees; How H.I.M. Directors deal?

Heather Chartier, MS, RHIA, CCA Revenue Cycle Leave a Comment

According to a Pew Research Center analysis, retirement looms for 3.5 million retirees over the next year, including the most recent labor force data.1 Many organizations face this worrisome predicament, yet many health information management departments struggle with being proactive in their planning efforts. This week's blog post asked three healthcare industry leaders...

OPPS FY2022 Final Rule - Overview

Gloryanne Bryant, RHIA, CDIP, CCS, CCDS Revenue Cycle Leave a Comment

The Hospital Outpatient Prospective Payment System (OPPS) Final Rule for Fiscal Year 2022 has been released by the Centers for Medicare and Medicaid Services (CMS). Included in the 1394 page OPPS final rule announcement that came on 11/2/2021 was the 2022 payment policy for Ambulatory Surgery Centers (ASCs) which is available at: ...

7 Points of Focus When Your Revenue Cycle Metric is Low

Heather Chartier, MS, RHIA, CCA Revenue Cycle Leave a Comment

Metrics represent values to measure an organization’s strategy. Leaders should understand that metrics cannot replace strategy. It can lead to behaviors that undermine the very strategy the metrics expect to measure, resulting in negative consequences for all. Remember the severe negative repercussions the banking giant, Wells Fargo experienced when it aggressively pushed...

CMS MA Star Ratings…..What are they?

Gloryanne Bryant, RHIA, CDIP, CCS, CCDS Revenue Cycle Leave a Comment

Across the Medicare Advantage (MA) Risk Adjustment (RA) healthcare world, we often hear about “Star Ratings.” With the October MA Star Ratings being released by the Centers for Medicare and Medicaid Services (CMS) a common question is: What are the CMS Star Ratings? CMS publishes the Medicare Part C and Part D Star Ratings each year to measure the quality of health and...

CMS Hospital Readmission Program: Penalties Announced

Gloryanne Bryant, RHIA, CDIP, CCS, CCDS Revenue Cycle Leave a Comment

Back in October 2012 (which is fiscal year 2013) the Hospital Readmission Reduction Program or HRRP was started in accordance with Section 1886(q) of the Social Security Act. This regulation set forth the statutory requirements for HRRP, which required the U.S. Department of Health and Human Services (HHS) via the Centers for Medicare and Medicaid Services (CMS) to reduce...

Considering Outsourced Services? Choose Wisely

Heather Chartier, MS, RHIA, CCA Revenue Cycle Leave a Comment

Summary   As the world of healthcare becomes more complex, healthcare executives are searching for ways to curb costs quickly and substantially while remaining competitive and profitable. Outsourcing is one way to reduce inefficiencies and eliminate redundancy. Let's explore some of the pain points health systems and hospitals face along with the pros and cons of using...

CMS Compliance Reminder and 3-Day Window Rule

Gloryanne Bryant, RHIA, CDIP, CCS, CCDS Revenue Cycle Leave a Comment

The Centers for Medicare and Medicaid Services (CMS) released a compliance reminder regarding, “Non-Physician Outpatient Services Provided Before or During Inpatient Stays: Bill Correctly” in their October 14th, 2021, Medicare Learning Network (MLN) news. Understanding this particular CMS policy, one needs to review the language: Medicare’s 3-day (or 1-day) payment window...

OIG Reports Medicare Overpaid Neurostimulator Implantation Surgeries $636 Million

Gloryanne Bryant, RHIA, CDIP, CCS, CCDS Revenue Cycle Leave a Comment

On October 1st, 2021, a report from the Office of Inspector General (OIG) was released regarding the Centers for Medicare and Medicaid Services (CMS) coverage violation of insertion or replacement of Neurostimulator Implantation surgeries. CMS had performed an analysis of prior Part B claims data and identified concerns and thus directed a supplemental post-payment...

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