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Category: Revenue Cycle Services

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Infusions: Will your documentation pass a Targeted Probe and Educate Review?

For years, Blue & Co. has received questions from hospitals regarding coding and billing for infusions, as well as documentation requirements. Infusion coding can be some of the most difficult coding for hospitals. It takes a certain understanding of 1) the required hierarchy, 2) what happens if a stop time is not recorded, 3) how […]

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Is Your Current Facility Emergency Department Leveling Process Working?

Blue & Co. has performed many Emergency Department Leveling Reviews for hospitals. The two most utilized leveling criteria are “points-based” or “intervention-based.” In either case, each hospital must determine which facility resources (or attributes) to include within its criteria, and how these resources crosswalk into ED visit levels (99281-99285). This can create significant reimbursement differences […]

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How Transparency and Patient Advocacy Can Reduce Your Hospital’s Bad Debt

In 2019 patient medical debt in the U.S. totaled at least $195 billion, according to an analysis by the Kaiser Family Foundation, a nonprofit organization focusing on national health issues. This is a massive figure and should be looked at as an opportunity for healthcare organizations. A survey conducted by Kaufman Hall in August 2020 […]

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Two Midnight Rule: How to Avoid an OIG Audit

The Two Midnight rule, adopted in October 2013 by the Centers for Medicare and Medicaid Services, states that more highly reimbursed inpatient payment is appropriate if care is expected to last at least two midnights; otherwise, observation stays should be used. Original Two Midnight Rule In general, the original Two Midnight rule stated that, Payable […]

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No Surprises Act: How to Ensure Compliance

In 2021, Center for Medicare & Medicaid Services (CMS) issued the No Surprises Act that went into effect on January 1, 2022. This Act provides Federal protections against surprise billing and limits out-of-network cost sharing under many of the circumstances in which surprise bills arise. Prior to this Act, individuals could be “balance billed” for […]

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Coding Changes are Coming, Ensure Your Organization is Ready

For discharges occurring on and after April 1, 2022, coders will have access to new ICD-10-CM and ICD-10-PCS codes. April 1st will also introduce the new Medicare Code Editor (MCE) edit 20 – Unspecified Code Edit. The 2022 IPPS Final Rule stated there would now be coding updates in both October and April. The goal […]

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2022 Physician Fee Schedule Final Rule: Highlights

Do you know that CMS is making significant changes to split/share and critical care services in 2022? Are your providers aware of the changes? Are they prepared to modify the documentation of these services? Are your coders prepared to report the required modifier? On November 2, 2021, CMS released the 2022 Physician Fee Schedule Final […]

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On-Demand Webinar: COVID-19 Vaccine Mandate in the Workplace

President Biden’s administration recently announced its Path Out of the Pandemic action plan which included specific guidance around a COVID-19 vaccine mandate. The action plan calls for employers with 100 or more employees to require employees to be vaccinated or submit to weekly tests, as well as requiring vaccinations for federal employees, contractors, and hospitals […]

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On-Demand Webinar: Why Documentation in Outpatient Rehabilitation Matters

Staying Ahead of the CMS Auditor: Why Documentation in Outpatient Rehabilitation Matters The Center for Medicare & Medicaid Services (CMS) suspended audits between March and August of 2020 to allow providers to focus on providing care during COVID-19. But now external audits in outpatient rehabilitation are ramping back up. Since the Office of Inspector General […]

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Physician Coding Changes to Address in 2021

This is the year for many changes in healthcare and the physician coding changes that were announced in March 2021 are just one piece of that. Evaluation and Management services (E/M) have not seen a change in more than 25 years; however, this year has significant changes for the office and outpatient locations. These physician […]

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Blue & Co., LLC acquires Alerding CPA Group

Blue & Co., LLC acquires Alerding CPA Group

Carmel, Ind. (November 23, 2022) – The accounting and consulting firms of Alerding CPA Group (Indianapolis, Ind.) and Blue & Co., LLC (Carmel, Ind.) have announced their merger. The combined firm will operate as Blue & Co., LLC (Blue & Co.), effective December 1, 2022. This acquisition will provide Blue & Co. with greater market […]

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Not-for-Profit Single Audit Requirements – Evaluation of Revenue Sources

By: Holly Fields, CPA, Senior Manager Not-for-profit organizations (NFPs) that receive federal financial assistance over certain levels, either directly from a federal agency or indirectly through state or local agencies, may be required to have a single audit performed under Federal Uniform Guidance. Single Audit Requirements A single audit includes not only an audit of […]

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Occupational Mix Survey: What You Need to Know

Every three years, the Centers for Medicare and Medicaid Services (CMS) requires any Hospital that is subject to the Inpatient Prospective Payment System (IPPS) to complete an Occupational Mix Survey (OMS). This data is then used to calculate an Occupational Mix Adjustment Factor (OMAF). The occupational mix adjustment impacts a hospital’s average hourly wage and […]

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