Providers often struggle with modifiers‑even those they've had available to report for many years‑due to the unique scenarios they face at their facilities, staffing changes, and/or unclear or lacking authoritative guidance.
CMS finalized its proposals regarding the 2-midnight rule, including moving responsibility for rule enforcement and education from Recovery Auditors to Quality Improvement Organizations (QIO). This latter change occurred October 1, 2015.
The 2016 OPPS final rule includes the first negative payment update for the system, but CMS also listened to commenters' suggestions to make a variety of proposals less onerous either operationally or financially.
CMS and the Office of the National Coordinator (ONC) released final rules October 6 with the intention of simplifying EHR requirements and allowing providers and consumers to exchange health information with greater flexibility. This includes the final rule with comment period for the EHR incentive programs and final rule for the 2015 edition health IT certification criteria.
Provider-based clinics and departments are increasingly common, but the rules for provider-based billing can often be confusing, especially given recent changes to modifiers and place of service codes.
Each new CMS fiscal year, MS-DRG weight and classification changes in the CMS IPPS final rule are closely scrutinized by the coders and clinical documentation improvement (CDI) specialists on the CDI team to identify any potential impact on documentation capture and code assignment processes.
Developing a strong denial management program may be one of the best ways to minimize the productivity and financial losses anticipated with the transition to ICD-10. By determining a baseline for denials and proactively identifying denial trends, organizations can efficiently resolve issues and reduce costs. An effective denial management program will help organizations to track, trend, resolve, and ultimately prevent denials.
