The combination of a nursing shortage and an increased need for case managers and social workers has some calling for case management leaders to step up to ensure the next generation is well prepared for the role.
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: 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.
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.
Do you have suggestions to meet the requirements to evaluate all those patients who have sedation and the ones who need to be seen in the emergency department?
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?
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?
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?
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.
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?
What do you do with a patient who does not have a safe discharge plan, but does not meet inpatient criteria and has been in observation status for 48 hours?
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.
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: Our pharmacy is asking if there is going to be payment for a new anti-hemophilia factor called Nuwiq. They say it is quite expensive and they want to know if there is additional payment for it.
Have you ever wondered how other HIM professionals work and how their departments operate? Now you can find out! HCPro's HIM Briefings is conducting a benchmarking survey on HIM roles and responsibilities, and we would appreciate your input. Please take a few moments to complete this survey.
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.
HCPro is gathering information about case management needs for future products. Please take this short survey and we will enter you in a drawing for a free, on-demand HCPro webcast of your choice! Click here to take the survey.
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: One of our physicians is talking about a new biological called Inflectra that he is interested in using. Do you have any information on how this is handled under the OPPS?
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 heard the 2-midnight rule is now gone based on changes to Medicare payment rates under the 2017 inpatient prospective payment system final rule. Is this true and if not what changed?
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.
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.
The American Medical Association recently released eight principles aimed at ensuring healthcare organizations use mobile health applications (mHealth apps) focused on safe and effective patient care.
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?
Case managers around the country are celebrating National Case Management Week, October 9–15, which recognizes the caregiving efforts of case managers throughout the year.
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.
How should case managers communicate with a patient when he or she lacks decision-making capacity but has no court-appointed guardian or power of attorney?
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.
Q. When issuing a MOON in a critical access hospital, how do we explain the patient financial responsibility since we are not paid the observation set amount?
If a patient doesn’t leave within a few hours upon being cleared and ready for discharge, and the reason is the family’s convenience, what options exist for a late discharge?
