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?
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?
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: 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.
Employing a comprehensive disease management program for hospital patients with chronic obstructive pulmonary disease (COPD) can significantly reduce hospital admissions and length of stay (LOS), according to a study published in the International Journal of Chronic Obstructive Pulmonary Disease. A comprehensive disease management program should include education, case management, and follow-up.
Q: We are having an internal disagreement regarding HCPCS code G0498. Our clinical department believes that this code is to be reported in addition to the chemotherapy administration charge. Our coders and chargemaster coordinator disagree and believe it is an all-inclusive code. Who’s right?
Q: We have received rejections for claims reporting the application of skin substitutes, with the edit stating there is a mismatch of the procedure and the skin substitute. We are using the table that was published in the 2017 OPPS final rule. Has something changed?
A recent study revealed good news for hospitals taking advantage of one or more Medicare value-based reforms. Participation in Medicare programs that focus on improving quality and value of care can often lead to a larger reduction in 30-day readmissions, according to JAMA Internal Medicine.
Q: We have started receiving rejections for claims with HCPCS code C1842 (retinal prosthesis, includes all internal and external components). We provide the service with the retinal implant and are confused why it's getting rejected.
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: 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?
Pokémon Go, the most popular mobile game app ever in the U.S., has captured the attention of players of all ages. But it could also be capturing sensitive images and information in hospitals, which could lead to a violation of HIPAA privacy rules.
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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?
I was under the impression that CMS said it would leave the billing for self-administered drugs to the OIG. However, we have not heard anything from the OIG. What if we are not billing for the medications?
Q: In my facility, we are supposed to send an email to our physician advisor (PA) and to administration if a query is not answered within a week. However, this policy doesn’t work well because administration does not do anything with that information, and the PA doesn’t have time to review unanswered queries. Do you have any suggestions concerning when to let a query go unanswered?
CMS’ proposed changes to implement Section 603 of the Bipartisan Budget Act of 2015 and reshape payments for off-campus, provider-based departments represent the most significant changes in the current year 2017 OPPS proposed rule.
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: We provide tobacco cessation services and have been reporting these with time-based HCPCS codes. There are also CPT® codes for these services. Which is the appropriate set of codes to use for Medicare?
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?
Nearly 20% of patients involved in a recent UT Southwestern Medical Center study were discharged from the hospital with one or more unstable vital signs, resulting in a higher number of deaths or readmissions than patients discharged with stable vital signs.
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.
Q: We are struggling with how to report the functional status codes that are required when a physical therapist provides therapy services post-operatively. We have a process for doing that for our “regular” therapy patients, but are struggling with how to implement this for the outpatient surgeries.
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.
Q: Our ophthalmologists are using mitomycin after surgery for many of their patients. Do we need to report a HCPCS code for this since it gets packaged into the surgery procedure? It seems like a lot of effort for no money.
I recently heard of a local long-term care hospital (LTCH, also known as LTACH) that was unwilling to accept military veterans who were cared for at her facility or any Veterans Affairs hospitals even though they would otherwise qualify for LTCH care. The reason the LTCH would not accept these patients was because they did not have a preceding visit in a “regular” hospital. What's the solution?
An inadvertent change in CMS guidance from “subsection (d) hospital” to “acute care hospital” to “IPPS hospital” resulted in eligible patients being denied admission to long-term care hospitals, but CMS has since revised its guidance.
Q: The influenza virus vaccine represented by CPT® code 90674 (influenza virus vaccine, quadrivalent [ccIIV4], derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use) was approved under the Medicare program as of August 1. However, our claims are kicking back when we report the code. Has there been a change?
When looking at the link between readmissions and hospital quality of care, it may be best to focus on patients who return to the hospital seven or fewer days after discharge, according to a recent Health Affairs study.
New CMS data revealed that efforts associated with the Affordable Care Act and Hospital Readmissions Reduction Program that 49 states and the District of Columbia have seen a drop in readmission rates.
What is the consequence if we miss giving a patient who meets the Medicare Outpatient Observation Notice criteria the notice? Has there been an update if the observation hours will need a modifier or the claim a value or condition code to show that the notice was given?
Hospitals got a last-minute reprieve from the Medicare Outpatient Observation Notice (MOON) notification requirement, which was set to go into effect August 6. Citing the need for additional time to revise the standardized notification form that hospitals will need to use to notify patients about the financial implications of being assigned to observation services, CMS moved back the start date for the requirement in the 2017 IPPS final rule to “no later than 90 days,” after the final version of the form is approved.