Radiation oncology services billed to CMS had a 9.6% improper payment rate in 2015, leading to Medicare improperly paying $137 million for these services, according to a study reported in the Medicare Quarterly Compliance Newsletter.
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!
As OPPS packaging has increased, providers may be less likely to appeal claims for certain denied charges based on medically unlikely edits, since it would not increase payments. However, providers should consider appeals when services are medically necessary and appropriate, as CMS bases future payment rates on accepted claims.
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.
With a new year underway, providers likely need to get a handle on some key new modifiers, as well as important changes to an existing modifier and the deletion of a modifier that previously raised a lot of questions and operational concerns.
This week’s Medicare updates include Medicare Outpatient Observation Notice (MOON) instructions, ICD-10 coding revisions to NCDs, a new “K” code for continuous positive airway pressure device bundle, and more!
