Incorrect inpatient rehabilitation facility (IRF) claims led to $444,458 in overpayments at Memorial University Medical Center, a Savannah, Georgia-based hospital, according to a recent Office of Inspector General audit report. IRF billing compliance has been on the OIG’s radar for several years, and Medicare Administrative Contractors and supplemental medical review contractors have been placing these claims under increased scrutiny.
This week’s Medicare updates include an advisory opinion on whether an excluded individual could be employed by an entity involved in federal healthcare programs; a pair of fact sheets on the cost and advancing care information performance category policies for MIPS in 2018; a video for medical offices on the new Medicare cards; and more!
In the 2018 OPPS final rule, CMS finalized a change to the current clinical laboratory date of service policies for outpatient molecular pathology tests and advanced diagnostic laboratory tests.
In the current healthcare climate, the issue of medical necessity documentation, or lack thereof, is one of the most common reasons for claim denials. For a service to be considered medically necessary (by a third-party payer), it must be considered a reasonable and necessary service to diagnose and/or treat a patient’s current and/or chronic medical condition.
One of the most memorable sessions at the AMA CPT Symposium in November 2017 involved an impromptu open mic feedback session facilitated by CMS’ Marge Watchorn, deputy director of the Division of Practitioner Services. The focus of this session was the applicability of the current CMS documentation guidelines for E/M services.
