Healthcare providers are often confused about what a commercial or managed care payer would want in order to approve the claim. Much of this confusion comes from the timing of requirements to ensure reimbursement.
The Government Accountability Office (GAO) has urged CMS to renew prior authorization programs slated to expire. The GAO made its case for continuing the programs in a report released in April, arguing that the programs reduced spending by nearly $2 billion since 2012.
CMS is looking to reduce reporting and documentation requirements for inpatient rehabilitation facilities (IRF) in the 2019 IRF payment system proposed rule, published in the Federal Register May 8. The proposed changes could come as a relief to IRFs that have seen a significant uptick in audits and denials.
The OIG will be scrutinizing how CMS collects overpayments, according to a recent update to its Work Plan. The agency will be looking at whether CMS followed recommendations to improve and increase collections.
A coding audit may be conducted by internal staff or external entities, typically representing the insurers paying for the care. When planning to implement a coding auditing program, the type of reviews, focus areas, and review frequency must all be taken into consideration.
CMS recently released MLN Matters SE18001 to provide healthcare practitioners with instructions and coding guidance for specimen validity when performed and billed in combination with drug testing. The article was issued to remind laboratories and other providers performing urine drug testing that specimen validity testing (SVT) is not separately billable.