This week’s Medicare updates include an OIG Advisory Opinion; new MOON FAQs; a CMS transmittal clarifying admission order and medical review requirements; and more!
In several recent reports, the Office of Inspector General (OIG) determined that providers are, on average, variant from expected volumes on both short stay inpatient and long stay observation cases. What was not made clear in the OIG report is the reason why it believes such variances exist. The answer to this question likely rests within the details of how hospitals have adjusted (or not adjusted) to the use and application of “new criteria” in their daily and ongoing Medicare billing compliance processes.
This week’s Medicare updates include the April 2017 Update of the Hospital Outpatient Prospective Payment System; the April 2017 Update of the Ambulatory Surgical Center Payment System; an National Coverage Analysis for Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD); and more!
As OPPS packaging has increased, providers may be less likely to appeal claims for certain denied charges based on medically unlikely edits, since it would not increase payments. However, providers should consider appeals when services are medically necessary and appropriate, as CMS bases future payment rates on accepted claims.
This week’s Medicare updates include a revision to State Operations Manual Appendix PP; ICD-10 Coding Revisions to NCDs, clarification of payment policy changes for Negative Pressure Wound Therapy using a disposable device and the outlier payment methodology for home health services; and more!
Accurate clinical documentation is the bedrock of the legal medical record, billing, and coding. It is also the most complex and vulnerable part of revenue cycle because independent providers must document according to intricate and sometimes vague rules.
