September 6, 2016
Medicare Web

Approximately 30% of 30-day readmissions among pediatric patients were found to be potentially preventable, according to a recent study in Pediatrics.

July 5, 2016
Medicare Web

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?

September 30, 2016
Medicare Web

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?

September 9, 2016
Medicare Web

What information should case managers provide to patients when they are returning home from the hospital?

August 16, 2016
Medicare Web

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.

July 26, 2016
Medicare Web

Hospitals with a decline in admission rates often experience a decline in 30-day readmission rates, according to a recent Health Affairs study.

October 11, 2016
Medicare Web

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.

October 7, 2016
Medicare Web

Q: Is it acceptable to keep patients in a discharge lounge after the discharge order is written but before the patient leaves the facility?

September 20, 2016
Medicare Web

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.

September 16, 2016
Medicare Web

What information should case managers provide to patients when they are transferring from a hospital to another healthcare facility?

August 23, 2016
Medicare Web

Now that CMS has released a new version of the Medicare Outpatient Observation Notice how should my organization proceed?

August 19, 2016
Medicare Web

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?

April 27, 2016
Medicare Web

Q: You previously talked about drugs with pass-through status beginning in April, but are there any other items with changes in the OPPS update? 

April 8, 2016
Medicare Web

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

April 5, 2016
Medicare Web

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? 

November 15, 2016
Medicare Web

Who should lead a facility’s revenue cycle plan?

April 15, 2016
Medicare Web

Q: What are some questions case managers can ask during the screening process?

October 18, 2016
Medicare Web

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.

April 19, 2016
Medicare Web

Q: What elements must be included for inpatient certification?

March 29, 2016
Medicare Web

Q: What are therapeutic services?

May 18, 2016
Medicare Web

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.

April 20, 2016
Medicare Web

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.

November 15, 2016
Medicare Web

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.

April 22, 2016
Medicare Web

Q: What should case managers do when a patient lacks decision-making capacity but has no guardian or power of attorney?

October 31, 2017
Medicare Web

CMS released a proposed rule October 27 that could add flexibility for states with regard to provisions of the Affordable Care Act.

December 6, 2017
Medicare Web

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

June 14, 2016
Medicare Web

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

June 8, 2016
Medicare Web

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?

 

December 13, 2017
Medicare Web

A recent analysis of patient financial transactions from more than 800 hospitals noted performance disparities among managed care payers for revenue cycle key performance indicators where accounts receivable and denials are concerned.

May 3, 2016
Medicare Web

Q: How can hospitals set charges for bedside procedures?

May 6, 2016
Medicare Web

Q. What are the requirements for critical access hospitals in relation to the latest proposed Conditions of Participation for discharge planning?

April 13, 2016
Medicare Web

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?

May 10, 2016
Medicare Web

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.

July 12, 2016
Medicare Web

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?

July 12, 2016
Medicare Web

Is diagnosis no longer a criteria for the observation APC payment?

May 10, 2016
Medicare Web

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

October 25, 2017
Medicare Web

Q: What are the core competencies of a case manager?

July 8, 2016
Medicare Web

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?

July 15, 2016
Medicare Web

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?

May 17, 2016
Medicare Web

Q: How should hospitals report bedside procedures?

November 8, 2017
Medicare Web

Q: How do I identify patients with health literacy problems, and what can I do to best assist them?

July 15, 2016
Medicare Web

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.

July 15, 2016
Medicare Web

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

July 19, 2016
Medicare Web

Can a hospital that is not a critical access hospital bill professional charges on UB-04 claims, Type of Bill 013X?

July 19, 2016
Medicare Web

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.

May 24, 2016
Medicare Web

Q: Who can complete inpatient certification?

 

May 24, 2016
Medicare Web

Q: Who can complete inpatient certification?

 

April 6, 2016
Medicare Web

Q: Did CMS ever add the drug screening HCPCS codes to the system so we can process these claims?

 

July 26, 2016
Medicare Web

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

July 27, 2016
Medicare Web

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.

April 26, 2016
Medicare Web

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

 

August 2, 2016
Medicare Web

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.

August 2, 2016
Medicare Web

What is a benchmark for conversion rates from observation to inpatient status?

November 10, 2017
Medicare Web

Alert fatigue defeats the purpose of EHR medication alerts, according to a recent study that looked at how often medication-related clinical decision alerts were overridden, the reasons given for the overrides, and how appropriate the reasons were.

November 22, 2017
Medicare Web

Q: What's a tool my staff can use to measure patient activation?

August 11, 2016
Medicare Web

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.

August 12, 2016
Medicare Web

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?

August 16, 2016
Medicare Web

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?

December 7, 2017
Medicare Web

Q: I am told if I elect to work from home, I will not be allowed to print any medical records. My home office is secure and I have a shredder. Would printing medical records violate HIPAA, or is this too restrictive?

August 17, 2016
Medicare Web

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?

August 19, 2016
Medicare Web

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. 

August 23, 2016
Medicare Web

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.

August 24, 2016
Medicare Web

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?

August 26, 2016
Medicare Web

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?

August 30, 2016
Medicare Web

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.

August 31, 2016
Medicare Web

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

September 6, 2016
Medicare Web

Is there any reason why an inpatient-only procedure would be performed on an outpatient?

September 2, 2016
Medicare Web

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.

 

September 7, 2016
Medicare Web

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.

September 16, 2016
Medicare Web

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. 

September 14, 2016
Medicare Web

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? 

September 20, 2016
Medicare Web

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

September 21, 2016
Medicare Web

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.

 

September 23, 2016
Medicare Web

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

September 27, 2016
Medicare Web

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?

September 27, 2016
Medicare Web

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

October 4, 2016
Medicare Web

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?

October 11, 2016
Medicare Web

How can hospitals differentiate the cost of care for bedside procedures from other services?

October 18, 2016
Medicare Web

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?

October 25, 2016
Medicare Web

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.

October 25, 2016
Medicare Web

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

October 21, 2016
Medicare Web

Can hospitals report more than 48 hours of observation services?

November 8, 2017
Medicare Web

As federal agencies release new and complex regulations for acute and postacute care facilities, providers are faced with the daunting task of unraveling and complying with the latest changes while ensuring patients receive quality care. 

November 1, 2016
Medicare Web

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

November 15, 2017
Medicare Web

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)

November 4, 2016
Medicare Web

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

November 8, 2016
Medicare Web

What factors indicate that an observation stay would be covered?

November 8, 2016
Medicare Web

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.

November 11, 2016
Medicare Web

What categories should a patient’s final discharge plan include?

October 25, 2017
Medicare Web

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.

November 21, 2017
Medicare Web

Participation in the Supplemental Nutrition Assistance Program can lead to decreased healthcare claims and out-of-pocket costs for low-income adults, according to a JAMA Internal Medicine study.

November 29, 2017
Medicare Web

Q: We keep hearing about the readmission metric – what does this metric refer to? 

November 18, 2016
Medicare Web

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

November 1, 2017
Medicare Web

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

November 22, 2016
Medicare Web

How can hospitals gain the support of the chief executive officer for revenue cycle team efforts?

November 22, 2016
Medicare Web

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.

October 19, 2016
Medicare Web

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?

November 13, 2017
Medicare Web

How should facilities approach claim edits that must be made across departments, such as imaging and surgery?

October 28, 2016
Medicare Web

What options for care/coverage does a patient have after receiving an Advance Beneficiary Notice?

June 28, 2016
Medicare Web

Q. Is it mandated to use the CMS MOON notice or can we construct our own notice?