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.

Ready to Meet PAMA Outreach Lab Reporting Requirements?

Hospitals nationwide are scrambling to comply with a new reporting mandate announced by Medicare in early 2019 within a densely written and widely misunderstood transmittal. The reporting, which is mandated by PAMA, requires applicable hospital outreach laboratories and physician clinics that perform specimen-only lab testing to report their commercial payor payment rates for lab services by the end of March 2020 or potentially face fines of more than $10,000 per day.