Here are the top five revenue cycle stories from 2023.
As we look forward to the new year, let’s look back at the top five revenue cycle stories of 2023.
CMS Releases Proposed ICD-10-CM Codes for 2024
Nearly 400 New Diagnosis Codes Coming This Fall, CMS Announces
When CMS’ released the 2024 inpatient prospective payment system rule, it included 395 new diagnosis codes. Additionally, there were 12 revisions and 25 deletions to the ICD-10-CM diagnosis code set.
Some of the new codes enhance the tracking and progression of Parkinson’s disease and more reimbursement for certain social determinates of health. The codes went into effect on October 1.
Medical, Insurer Groups Ask CMS to Not Implement Prior Authorization Provisions
The American Hospital Association (AHA), the American Medical Association (AMA), the Blue Cross Blue Shield Association wrote a letter to CMS asking the organization not to implement its proposed prior authorization standards. The groups argued that the provisions would create two sets of standards that would slow implementation and add unnecessary costs.
Denials Management Once Again Strikes a Chord With Revenue Cycle Leaders
In a survey by AKASA, revenue cycle leaders said that their most time consuming tasks were denials management and prior authorizations. Other issues included insurance follow-up, eligibility and medical necessity checks, along with patient cost estimation and price transparency requirements.
Cigna Sued for Allegedly Using Algorithm to Deny Claims
Allegedly, Cigna’s PXDX algorithm has been denying claims automatically without a proper review process. The algorithm previously caused issues for the insurer when it was reported that it denied 300,000 requests for payments over two months in 2022.
Jasmyne Ray is the revenue cycle editor at HealthLeaders.