OUR SUCCESS
TEAM HARMONY BLOG
Critical CMS Updates Your Healthcare Organization Needs to Know
Centers for Medicare and Medicaid Services (CMS) issued a press release at the end of May stating that they will be ramping up Risk Adjustment Data Validation (RADV) audits. There will be 2000 coders auditing 200 patient charts across 550 Medicare Advantage (MA) plans. The numbers are up from 40 coders auditing 35 patient charts across 30 MA plans prior to these planned audits. These retrospective reviews will occur from 2018-2024 and should be completed by early 2026. Extrapolation will occur following the audit to recoup the estimated $17 billion in overpayment to MA plans. Outpatient Clinical Documentation Integrity (CDI)…
Common Pitfalls in Revenue Cycle Management and How to Avoid Them
Revenue Cycle Management (RCM) is the backbone of healthcare finance, encompassing every step spanning from patient registration to final payment. However, many organizations face recurring pitfalls that can drain revenue, frustrate staff, and diminish patient satisfaction. Here’s a look at the most common RCM pitfalls and actionable strategies to avoid them. Incomplete or Inaccurate Patient Information One of the most frequent RCM errors is collecting incomplete or incorrect patient data during registration. Even minor mistakes like a misspelled name or wrong insurance ID can lead to claim denials and payment delays. How to Avoid: Train front-desk staff to verify all…
Implementing a Successful Outpatient Clinical Documentation Integrity Program: Best Practices
Outpatient Clinical Documentation Integrity (OP CDI) programs are essential for healthcare organizations aiming to improve documentation accuracy, ensure compliance, reduce denials, and optimize reimbursement. As care shifts to outpatient settings, the need for robust CDI programs outside the hospital grows. Here are seven key steps and best practices for implementing a successful outpatient CDI program, supported by industry guidance and expert recommendations. 1. Define Clear Goals and Scope Set specific objectives for your CDI program, such as improving risk adjustment scores, reducing claim denials, enhancing quality measures (e.g., MIPS/MACRA), and ensuring accurate reimbursement. Also, determine the scope of the program.…
