CMS packed some potentially game-changing proposals into a pared-down fiscal year (FY) 2021 inpatient prospective payment system (IPPS) proposed rule. Understand how these proposals could have far-reaching implications for hospitals.
Modifier -22 indicates that the procedural work performed by the provider or surgeon was substantially greater than what is typically required. The application of this modifier allows providers to receive additional reimbursement for a procedural service that was especially challenging, time-consuming, or unusual.
CMS updated its novel coronavirus (COVID-19) fee-for-service billing FAQs on April 23 and May 1. The updated FAQs address the appropriate use of disaster-related modifiers, remote physiological monitoring (RPM), and more.
CMS released a new interim final rule with comment period that grants organizations another round of flexibilities to meet the challenges of the COVID-19 public health emergency, including permitting hospitals to bill for telehealth services and loosening restrictions on COVID-19 testing.
Clinical validation reviews and queries ensure that the documented diagnoses and clinical indicators hold up to inspection. Use these strategies to head off clinical validation reviews and improve documentation.
Like other services covered by Medicare, observation must be reasonable and necessary or, in other words, medically necessary. The physician must document that they assessed patient risk to determine that the patient would benefit from observation services.
The American Medical Association (AMA) announced on March 26 new CPT coding and reporting guidance for physicians and medical practices, intended to simplify reporting of in-person and online visit services for novel coronavirus (COVID-19) patients.
With the release of a new ICD-10-CM code for the novel coronavirus (COVID-19), hospitals now have a method to capture and report this critical disease. Although the code itself is relatively straightforward and likely won’t stir up confusion the way coding for complex diagnoses (such as sepsis) does, correctly documenting and coding COVID-19 is crucial to turning the tide on the national public health emergency.