Reimbursement for provider-based departments (PBD) can be complex, and regulations affecting it have changed frequently over the past year. Section 603 of the Bipartisan Budget Act of 2015, the 2017 outpatient prospective payment system (OPPS) final rule, and the 21st Century Cures Act changed the payment methodology and made multiple adjustments to the definition of excepted (on-campus or grandfathered off-campus) and non-excepted (off-campus) PBDs. Hospitals must know the regulations inside and out and understand how they apply to their PBDs and to avoid denials or noncompliance.
This week’s Medicare updates include the April 2017 Medicare Quarterly Provider Compliance Newsletter, scribe services signature requirements, outlier limitation on OPPS Community Mental Health Centers Services, and more!
Traditionally, the OPPS rulemaking cycle has been the main vehicle for changes to outpatient coding and billing regulations and policy that hospitals need to pay attention to. But increasingly, CMS has been introducing or discussing changes relevant to outpatient hospitals beyond the scope of the OPPS rules.
This week's note from the instructor discusses several changes regarding inpatient-only procedures that might have flown under the radar for some hospitals.
This week’s Medicare updates include an OIG report regarding hospital noncompliance with Medicare Requirements for billing outpatient right heart catheterizations with heart biopsies; a new educational initiative to raise awareness of chronic care management; quarterly updates to the ESRD PRICER; and more!
Coders prepared for 2017 with numerous changes to the Official Coding Guidelines for the ICD-10-CM and the addition of many new codes. Quietly waiting in the wings was the updated CPT® Manual for 2017 with its changes waiting to be discovered.
