Q: It is my understanding that we can make PHI disclosures using our EHR for payment/treatment/healthcare operations without a consent and that we do not need to track these requests for an accounting of disclosures. Has this changed?

The National Association of Healthcare Revenue Integrity is currently seeking speakers to present at the 2018 Revenue Integrity Symposium, to be held October 16–17, 2018, in Litchfield Park, Arizona. Is that special person you or a colleague?

Q: Which hospital patients must be screened an assessed for a discharge plan?

Q: Our state child support enforcement agency requested the medical records of one of our pediatric patients. Are we allowed to respond to this request without a subpoena?

How can case managers improve teamwork across the continuum of care?

The North Dakota Department of Human Services’ claims for Medicaid reimbursement for Targeted Case Management Services did not meet all federal requirements and lacked appropriate policies and procedures for claims, according to the Office of Inspector General.

Q: How can hospitals set charges for bedside procedures?

Q: We have started using what our physicians call “high-frequency” neurostimulators. I know there are two HCPCS codes for reporting these to Medicare, but how do we know what is high frequency and what is not?

Q: Rural health clinics have to start to bill all services on individual lines with HCPCS codes and charges. Is there a way to report these services on a separate line without the appearance of inflating our charges? 

How can discharge planners collect discharge planning data? What type of software supports data collection?

According to report, at least 50 employees of Northwestern Memorial Hospital in Chicago were fired for accessing the medical record of actor Jussie Smollett without authorization.

Q: What are therapeutic services?

The acute kidney injury (AKI) dialysis payment rate is $232.37 for CY 2018, as updated by CMS in the 2018 End-Stage Renal Disease Prospective Payment System (ESRD PPS)

We found out after an observation patient was discharged that one of the procedures performed was an inpatient-only procedure. Can we bill this to Medicare without an official inpatient order on the medical record?

Is the MOON notice required for patients in outpatient and a bed status, such as extended recovery?

Q: CMS released guidance last summer about not auditing or counting errors for the specificity of an ICD-10-CM code. CMS is not going to count the code as an error as long as the first three digits are correct. Does this apply to medical necessity diagnoses and edits?

The numbers are in and some 12.7 million Americans signed up for a health plan during the Health Insurance Marketplaces open enrollment period. Some 9.6 million people enrolled through HealthCare.gov and 3.1 million through marketplaces in their home state.

Q: Is there a difference in the documentation requirements for bedside procedures when performed on an inpatient versus outpatient?

Q: Do you have any advice for what to do when confronted with a duty-to-warn situation?

My understanding is that under the 2-midnight rule CAHs cannot go past two midnights of observation care if the patient has Medicare as a payer. Is that correct?

Q: Are there any new HCPCS codes for recently released biosimilar products on the horizon? Our physicians and pharmacists are being contacted by the manufacturer about purchasing and using them, but we want to be sure we can report them appropriately.

My understanding is that under the 2-midnight rule CAHs cannot go past two midnights of observation care if the patient has Medicare as a payer. Is that correct?

Q: Who can complete inpatient certification?

Can a facility begin physical therapy treatment if the order has not been authenticated?

The majority of patients who visit hospital emergency departments for chest pain do not have a life-threatening condition, according to a recent study in JAMA Internal Medicine.

Q: An investigator from the state health department called the clinic where I work and asked for health records to collect vaccination data for a public health project. Is it a HIPAA violation to share that data?

What does it mean when a service is nonreportable for a patient in observation?

Q: What should the utilization review committee look for when an inpatient stay is less than two midnights?

When it comes to providing high-quality patient care, most American hospitals simply don’t. That’s if the recent round of five-star rankings from CMS are to be believed. About 1,700 hospitals (39%) earned just three out of five stars, an “average” rating, FierceHealthcare reported.

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The August 2 issue of Revenue Cycle Daily Advisor included a question about benchmark conversion rates from observation to inpatient status. With regard to that question, I think it may be helpful to know the average national conversion rate and average rate for critical access hospitals. Do you have that information?

The overall monthly national healthcare spending rate modestly increased 4.3% from August 2016 to August 2017, with a notable increase in home health spending, according to a brief from Altarum’s Center for Sustainable Health Spending.

How can we define the role of the nonlicensed case manager extender within our interdisciplinary team?

CMS’ introduction of CMS-1455-R in March 2013 allowed hospitals to ignore the one-year timely filing deadline and rebill admissions that were denied by an auditor, even many years after the date of service. Fast forward to October 29, 2015, when the OIG released a policy stating that hospitals may waive the cost of self-administered medications to Medicare beneficiaries without concern about inducement or kickback accusations if the hospital develops a policy and applies it uniformly.

Q: I have a question about navigating the skilled nursing facility (SNF) benefit for Medicare. My understanding is that you can only use a Hospital-Issued Notices of Noncoverage (HINN) for inpatient, so you could use if less than a three-day stay. We have been giving Advance Beneficiary Notices (ABN) for our traditional Medicare patients that are observation when families are not timely on getting a SNF secured to those patients that require it. Is this correct?

Q: Is there any information yet on any new HCPCS codes for pharmacies that CMS may be considering for the October OPPS update?

CMS wants your thoughts on its 2017 OPPS proposed changes. In various places in the proposed rule, CMS specifically asks providers to comment on the proposals. You may submit comments to the agency until September 6.

With the first data reporting period beginning January 1, 2017, for CMS’ revamped Clinical Laboratory Fee Schedule, the agency has released a user guide and template to aid providers who are required to submit the data. 

How are bedside procedures defined and what is an example of these procedures?

What is the current status of the Beneficiary and Family Centered Care Quality Improvement Organizations (BFCC-QIO) short-stay reviews?

When is the recommended time to write an order for an inpatient-only procedure?

According to a report published by Change Healthcare, 23.9% of claim denials are due to errors during front-end revenue cycle processes such as registration and eligibility.

Is it appropriate for a critical access hospital hospital to bill with Type of Bill (TOB) 013X versus TOB 085X, or are they only to bill with 085X?

What are the requirements for compliantly using condition code 44 to change a patient’s status?

Please explain the separate procedure exception for inpatient-only procedures.

Medicare beneficiaries sometimes have information about discharge planning from CMS. What questions might they ask as a result of having this information?

Including patients and families/caregivers in daily hospital rounds and bedside conversations can provide patients and their families with better insight into care and enable active participation.

Q: What's the distinction between the case manager and non-lincensed case manager extender?

A Comprehensive Error Rate Testing (CERT) study showed insufficient documentation causes most improper payments for arthroscopic rotator cuff repairs, according to the October 2017 Medicare Quarterly Compliance Newsletter.