Q: How should we handle denied claims when the payer refuses payment under the billed status? Do we need to document that the status was changed only because the payer did not agree to any other options?
CMS is moving forward with multiple policies—effectively based on reducing reimbursement to hospitals—that have been deemed unlawful in court, according to the 2020 OPPS final rule, released Friday, November 1. However, the agency pushed its controversial price transparency proposals to a separate, yet-to-be released final rule.
In today’s virtual environment, with its focus on flexible schedules, organizing the coding function requires consideration of time zones, team member skills, volume of work, and claim-processing schedules.
The fiscal year (FY) 2020 ICD-10-CM Official Guidelines for Coding and Reporting, released shortly after the FY 2020 ICD-10-CM code release, provide instructions for healthcare professionals on how to appropriately report complex diagnoses. Coders should take time to review these changes that were implemented October 1.
This week’s Medicare updates include the October edition of the Medicare Quarterly Compliance Newsletter, a pair of requests for information on potential usage of artificial intelligence to prevent fraud, Medicare Advantage billing instructions for CAR-T therapy, and more!
Chimeric antigen receptor T-cell (CAR-T) therapy provided to Medicare Advantage (MA) beneficiaries will be paid for by traditional Medicare for calendar years 2019 and 2020.
