Hospital Revenue Cycle

Report Medicare bad debt on the Medicare cost report (CMS-2552) — 42 C.F.R.

Classify CARC/RARC remittance advice remark codes on an 835 remit, triage denial root cause, and generate a payer-ready appeal letter with supporting clinical o

Audit hospital chargemaster (CDM) compliance against CMS Hospital Price Transparency Final Rule 2024 requirements — machine-readable file (MRF), consumer-shoppa

Design and audit a hospital's financial assistance policy (FAP) — IRS §501(r)(4) requirements for tax-exempt hospitals, covering application process, income eli

Navigate all five levels of the Medicare appeals process for Part A and Part B claims — redetermination, reconsideration (QIC/BFCC-QIO), ALJ hearing, Medicare A

Validate ICD-10-CM principal and secondary diagnosis assignment against MS-DRG grouper logic to identify missed complication/comorbidity (CC) and major complica

Manage Medicaid eligibility pending and redetermination (redet) workflows for hospital revenue cycle — presumptive eligibility, retroactive eligibility backdati

Navigate the No Surprises Act independent dispute resolution (IDR) process for out-of-network payment disputes, including the 30-day open negotiation window, ID

Healthcare Revcycle PRO Observation 2midnight Parta Partb — buyer-grade workflow.

Navigate Outpatient Prospective Payment System (OPPS) APC payment logic for hospital outpatient claims — APC assignment from HCPCS/CPT codes, status indicators,

Manage prior authorization denials for physical therapy and occupational therapy services — Medicare 2024 rules, including ABN (Advance Beneficiary Notice of No

Medicare 3-day payment window rule for pre-admission outpatient services that must be bundled into the inpatient DRG payment.