Tag: compliance

How Charge Capture Audits Boost Your Healthcare Revenue

How Charge Capture Audits Boost Your Healthcare Revenue

The healthcare industry holds hidden potential for improved revenue and streamlined operations. Charge capture audits act as your key to unlock these hidden treasures. Similar to explorers seeking buried riches, healthcare organizations can embark on a quest for financial stability through these audits. This guide will explain charge capture audits, help you identify hidden opportunities, […]
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The Impact and Challenges of Medicare Advantage for Payers and Providers

The Impact and Challenges of Medicare Advantage for Payers and Providers

Medicare Advantage (MA) is becoming more appealing to payers due to its numerous benefits, but providers are struggling to adjust to its effects. Payers are increasingly recognizing the advantages of MA, especially in terms of profitability. According to a study conducted by the Kaiser Family Foundation (KFF), MA insurers disclosed an average gross margin of […]
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CMS Rules for Coding Emergency Department Claims | Best Practices

CMS Rules for Coding Emergency Department Claims | Best Practices

The Centers for Medicare and Medicaid Services (CMS) has consistently authorized hospitals to establish and utilize their own coding guidelines for emergency department facility claims. CMS makes clear that “[a]s long as the services furnished are documented and medically necessary and the facility is following its own system, which reasonably relates the intensity of hospital […]
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