Hospitals Can Improve Collections by Targeting CARC 24 Denials

Hospitals can quickly and dramatically improve collections by reducing Claim Adjustment Reason Code (CARC) 24 denials, or claims rejected due to incorrect Medicare and Medicaid submissions.

Order-of-Insurance Denials Costs Money, Damages Patient Experience

When it comes to payment denials, some of the most common and potentially damaging involve Claim Adjustment Reason Code (CARC) 22, or order-of-insurance coverage problems. CARC 22 denials reduce cash flow, trigger unnecessary patient invoicing, and may undermine customer goodwill and harm the hospital’s overall patient experience and brand.

CMS Imposes Prior Authorization for Specified Outpatient Procedures

Medicare recently finalized a plan that will require hospitals to obtain prior authorization before performing certain outpatient procedures. Understanding these changes will be critical to avoid unnecessary denials beginning on July 1, 2020.

CMS Works to Ease RAC Audit Burden, Reduce Denial Backlog

Long a thorn in the side of hospitals nationwide, Recovery Audit Contractor (RAC) program recently underwent substantial changes which CMS say will make the audit process significantly less burdensome for providers.

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Support Act Creates New Bundled Opioid Treatment Payments

Hospitals on the front lines of the opioid epidemic have new tools to address the scourge of opioid misuse and addiction, including bundled Medicare reimbursements for holistic treatment services.
On Jan. 1, 2020, a bundled Medicare payment became available to hospitals to support comprehensive treatment of opioid disorders. The new reimbursement opportunity is one of several provisions in the act aimed at mitigating opioid misuse risk among Medicare beneficiaries.

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