News & Analysis

June 29, 2017
Medicare Insider

This week's note offers guidance on CPT E/M codes for new versus established patients and addresses OIG reports on E/M codes audits.

June 14, 2017
Medicare Web

CMS has released the final 2018 ICD-10-CM codes to be implemented October 1, with hundreds of changes from the version released in the 2018 IPPS proposed rule. 

June 1, 2017
Briefings on APCs

CMS issued SE1609 to clarify long-standing policy concerning external infusion pumps. Apparently, both freestanding physician offices and outpatient hospital departments were treating external pumps as an item of durable medical equipment, even when the physician or hospital department set up the pump on the patient, supplied the drug, and programmed the infusion rate and dose into the pump.

June 1, 2017
Briefings on APCs

Ochsner Clinic Foundation began its ambulatory clinical documentation excellence journey in 2004, when Medicare implemented its Hierarchical Condition Categories (HCC). Since HCCs affect patients’ Risk Adjustment Factor scores, and ultimately reimbursement for the care required to treat sicker patients, Ochsner needed to determine the best way to ensure annual HCC capture for all patients across its vast system.

June 1, 2017
Briefings on APCs

There is an extensive list of coverage requirements that must be met to furnish outpatient ser­vices to Medicare beneficiaries. Hospitals may find that certain coverage requirements for therapeutic and diagnostic service are more difficult to meet than others, especially in off-campus provider-based departments.

May 31, 2017
Medicare Insider

This week's note discusses reimbursement for “nonexcepted” provider-based departments.

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