Changes coming in 2021 2020 looks to be a transition year on the payment front, as many programs and changes expected to go into effect this year have been delayed until 2021. These include new CMS-created primary care models and a streamlining of evaluation and management level-of-care coding. CMS announced in October its newest alternative […]
National Rural Health Center
https://www.ruralcenter.org/ Collaborating and innovating to improve the health of rural communities.
Clean Claim Rate (CCR) and First Pass Rate (FPR)
Two metrics important to the discussion of creating claims most likely to be immediately reimbursable are Clean Claim Rate (CCR) and First Pass Rate (FPR). Though sometimes confused for one another, these are separate statistics, each worthy of optimization. HFMA identifies the value of CCR as an indicator of the quality of data collected and reported. […]
EAPG
Blue Cross Blue Shield Enhanced Ambulatory Patient Grouping (EAPG) methodology for calculating reimbursement for outpatient procedures http://www.okoha.com/OHA/Hotline/2015/April15/Taking_charge_of_the_EAPG__Improve_your_negotiations_with_BCBS.aspx
Link to Medicare Quality Payment Program home page
https://qpp.cms.gov/
Core Quality Measures
Overview There is a great demand today for accurate, useful information on health care quality that can inform the decisions of consumers, employers, physicians and other clinicians, and policymakers. This is increasingly important as the health care system moves towards value-based reimbursement models. It is difficult to have actionable and useful information because physicians and […]
Preventing Medical Necessity Denials
Preventing Medical Necessity Denials KAREN HOPPE Although all hospitals must comply with a Medicare requirement that services provided to beneficiaries are reasonable and medically necessary for treatment and diagnosis, the criteria may be inconsistent among the agencies setting them. The Centers for Medicare & Medicaid Services (CMS) created policies that dictate the criteria that […]
HFMA MAP Keys
KPI’s from HFMA MAP Keys program MAP Keys are industry-standard metrics or KPIs usedto track your organization’s revenue cycle performance usingobjective, consistent calculations. http://www.hfma.org/MAP/mapkeys/ map-award-tables_061616-2
ERP
Enterprise Resource planning Enterprise resource planning (ERP) is an industry term for the broad set of activities that helps an organization manage its business. An important goal oF ERP is to facilitate the flow of information so business decisions can be data-driven. ERP software suites are built to collect and organize data from various […]
Making RVUs Work for Your Medical Practice
Resource -Based RVU defined July 01, 2014 Linked Articles The Basics of Making RVUs Work for Your Medical Practice RVUs Remain a Relevant System to Determine Physician Compensation Assigning RVU Values to Procedures That Don’t Have Them Using RVUs to Measure Physician Performance Calculate Your RVU Payment Cost Accounting in the Medical Practice via RVU […]
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