So many people struggle early in their careers with finding a perfect fit for their talents and passion. My story is exactly the opposite. My entire family is in healthcare, so I chose my career quite naturally. Though I had a bit of a circuitous route into my final landing place, I cannot say I'm surprised to have landed here.
In the 2017 OPPS proposed rule, CMS is proposing to continue its comprehensive APC (C-APC) policy first implemented in 2015 and has proposed 25 new C-APCs for 2017 in addition to the existing 37 C-APCs.
An Oregon academic health center agreed to a $2.7 million HIPAA violation settlement fine and corrective action plan (CAP) after a breach investigation revealed serious HIPAA vulnerabilities throughout the organization, HHS said in a statement released July 18.
CMS' Transmittal 3523, issued May 13, is the quarterly July 1 OPPS update. In this transmittal, CMS briefly mentions billing physical and occupational therapy and speech-language pathology services provided in support of or adjunctive to comprehensive APC (C-APC) services under revenue code 0940 (general therapeutic services) rather than the National Uniform Billing Committee‑defined revenue codes for these services (i.e., 042x, 043x, and 044x, respectively).
CMS issued a final rule in June to revamp the way it pays for tests under the Clinical Laboratory Fee Schedule (CLFS), though the agency has pushed the start date back a year and worked to ease administrative burden based on public comments.
"This, along with some other changes CMS finalized based on commenter concerns and additional analyses, is really good news for providers," says Jugna Shah, MPH, president and founder of Nimitt Consulting, Inc. "It's all in the spirit of reducing provider burden."
Now starting January 1, 2018, CMS will base CLFS payments on the weighted median amount paid by private payers for the same services. Providers are hopeful that these new weighted median rates based on a different process from the existing CLFS updating process, which has remained relatively unchanged since its establishment in 1984, will result in more accurate rates, says Shah.
Applicability
In order to develop the new rates, CMS will require "applicable laboratories to report applicable information" to the agency.
An applicable lab is defined as one that receives at least $12,500 in payments under the CLFS, and more than 50% of Medicare revenue from laboratory and/or physician services over the data reporting period to report private payer rates and test volumes for laboratory tests.
These thresholds will exclude approximately 95% of physician office laboratories and 55% of independent laboratories from having to report information, along with just about all hospital labs, according to CMS.
The applicable information required to be reported is:
The payment rate that was paid by each private payer for each test during the data collection period
The volume of such tests for each such payer
CMS originally proposed to use Taxpayer Identification Numbers (TIN) to identify applicable laboratories, but in the final rule made a change to use National Provider Identifiers (NPI). In order to keep administrative burden at a minimum, CMS will continue to apply the reporting requirements at the TIN level, making those entities responsible for reporting all NPI-level information for its applicable laboratories.
CMS also clarified that the information that must be reported is tied to payments received, which means that if a claim was submitted but payment was not yet received or was denied, that data would not be reported to CMS.
The data reporting period has been shortened from one year in the proposed rule to six months in the final rule. The first data collection period is from January 1‑June 30, 2016. That collected data will have to be reported to CMS from January 1‑March 31, 2017.
CMS plans to follow this schedule for subsequent collecting and reporting periods, which will occur every three years for all CLFS tests except Advanced Diagnostic Laboratory Tests (ADLT), which will have more frequent data collection and updating.
CMS has defined an ADLT as a clinical diagnostic laboratory test that is covered under Medicare Part B and offered and furnished by only a single laboratory, and only sold for use by the original developing laboratory, or a successor owner.
The test must also meet the following criteria:
The test is an analysis of multiple biomarkers of DNA, RNA, or proteins combined with a unique algorithm to yield a single patient-specific result
the test is cleared or approved by the Food and Drug Administration (FDA)
the test meets other similar criteria established by the secretary of HHS
In response to public comments to the proposed rule, CMS changed the definition of ADLTs, which originally only included molecular pathology analysis and did not include protein-only based tests.
ADLTs have been established by the agency in order to recognize when a laboratory has expended all of the resources associated with a test, including development, marketing, and selling.
The $12,500 threshold for CLFS payments will not apply with respect to ADLTs. If a laboratory would otherwise meet the definition of applicable, excepting the $12,500 threshold, CMS will consider it applicable with respect to the ADLT and it must report the applicable information pertaining to the ADLT.
Congressional legislation is often written in a way that obfuscates or, at the very least, makes it difficult to discern the impact or intent of a bill.
Anatomical modifiers qualify a HCPCS/CPT® code by defining where on the body the service was provided. These modifiers are especially helpful to indicate services that would normally be considered bundled but were actually performed on different body sites.
When compared to data from past surveys, HCPro's 2016 HIM director and manager salary survey revealed a harsh truth that many HIM professionals already know: There has been little movement in HIM manager and director salaries over the years.
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.
The cost of healthcare is quickly rising across the nation and patients are shouldering the majority of the price increases through higher deductibles and out-of-pocket expenses as expenditures continue to shift from employers to patients.
