News & Analysis

March 1, 2019
Briefings on APCs

In the 2018 OPPS final rule, CMS removed total knee arthroplasty (TKA) from the inpatient-only (IPO) list effective January 1, 2018. Although some guidance was provided at the time, providers and physicians alike were left confused with a significant number of questions regarding documentation and inpatient status

February 27, 2019
Medicare Web

Community Hospital in Munster, Indiana, is disputing an Office of Inspector General (OIG) report that found DRG assignment errors and incorrect inpatient rehabilitation facility (IRF) claims, resulting in an projected $22,051,602 in overpayments.

February 1, 2019
Briefings on APCs

Modifier -JW is used to describe drug amounts that are discarded and not administered to any patient. This does not reduce the payment for the drugs, so this is an informational modifier, but it is a mandatory modifier.

January 23, 2019
Medicare Web

The Office of Inspector General (OIG) will be taking a closer look at payments for inpatient claims subject to CMS’ post-acute transfer policy, according to a recent update to the OIG work plan.

January 2, 2019
Medicare Web

Revenue integrity auditors can monitor multiple priorities more efficiently with data analytics and decision support systems.

December 1, 2018
Briefings on APCs

Follow the steps a hospital should consider when submitting a redetermination request to a Recovery Auditor.