The COVID-19 pandemic continues to cause extreme financial hardship for hospitals, health systems and all providers. Falling operating margins and increasing denials make it even more important to stay abreast of regulatory changes regarding COVID-19.
Completing Medi-Cal forms can be challenging. Knowing what form to use based on the scenario and the time of request is important. There is also an alternative to the handwritten requirement.
From flu to tetanus, and now COVID-19, vaccines are among the most common outpatient procedures providers administer on a day-to-day basis. But they can also be complex to code and bill, and undetected mistakes can result in continual underpayment for services rendered.
Completing Medi-Cal forms can be challenging. Knowing what form to use based on the scenario and the time of request is important. There is also an alternative to the handwritten requirement.
The PAMA law brought a wide variety of changes to Medicare, including the method by which Medicare will calculate the rates it will pay under the Clinical Lab Fee Schedule. Data collected from the period of Jan. 1, 2019-June 30, 2019, must now be reported to Medicare between January 1 and March 31, 2022 or potentially face fines of more than $10,000 per day.
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 quickly and dramatically improve collections by reducing Claim Adjustment Reason Code (CARC) 24 denials, or claims rejected due to incorrect Medicare and Medicaid submissions.
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.
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.
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.
