Livanta Launches New Publication, The Livanta Claims Review Advisor, for Healthcare Providers
To share general review findings and to offer related insight to healthcare organizations, Livanta LLC ("Livanta") is pleased to launch its newest publication, The Livanta Claims Review Advisor. Each month, the content will address proper billing practices for inpatient claims with short stays or certain types of claims reimbursed under the diagnosis-related group (DRG) inpatient prospective payment system (IPPS). With this e-publication, Livanta will highlight areas of interest for medical coders and their leadership; billing, financial, and revenue cycle personnel; clinical documentation improvement specialists; utilization review coordinators; case managers; and compliance officers, physicians, and other practitioners.
In 2021, the Centers for Medicare & Medicaid Services (CMS) awarded Livanta a national contract to conduct claim reviews for Medicare. Claim review services represent an important activity of advancing Medicare's aims of better health, better care, and lower costs. Medicare's claim review program includes activities that evaluate the following two main types of Medicare Part A claims that have a high potential for errors:
(1) Hospital inpatient admissions of short duration, and
(2) Re-submitted claims for higher payments than initially billed under IPPS with a DRG, i.e., a higherweighted DRG (HWDRG).
Livanta's Chief Medical Officer, Ellen R. Evans, MD, a Board-certified Family Physician and Geriatrician, stated, "The Livanta team of clinicians brings exemplary experience, knowledge, understanding, and skill to this workload. Through this work, Livanta recognizes the significance of claim reviews to ensure appropriate Medicare billing to protect the Medicare Trust Fund. This new publication is one more way that Livanta provides valuable education to the healthcare provider community."
Medicare uses DRG codes to determine reimbursement to hospitals of acute-care inpatient claims. DRG coding helps ensure equitable payments across various patient conditions and locations. Submitting adjustments to claims that result in higher-weighted DRG codes may trigger reviews of inpatient claims. Claim reviews for short hospital stays focus on the claims submitted by providers for patients admitted to the hospital but discharged less than two days later.
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