Portrait of a sick patient coughing into tissue being helped via tele medicine by a male doctor wearing blue scrubs uniform using laptop

Take Steps to Stay Abreast of Evolving Telehealth Reimbursement

The use of telehealth has skyrocketed due to the COVID-19 pandemic. However, long-term uncertainty about Medicare reimbursement and wide disparities in the way commercial payers and Medicaid programs reimburse for telehealth mean providers must be extra-vigilant to limit denials and underpayments. Financially hard-hit providers must consider new revenue cycle management protocols to ensure the best chance for full reimbursement.

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.