News & Analysis

November 12, 2015
Medicare Insider

This week’s note is on billing changes for off-campus hospital departments.

September 29, 2015
Medicare Insider

This week’s updates include: Claims processing Medicare Secondary Payer (MSP) policy and procedures regarding ongoing responsibility for medicals (ORM); Maintenance and update of the temporary hook created to hold OPPS claims that include certain drug HCPCS codes; and more!

September 1, 2015
HIM Briefings

CMS has sharply accelerated its push toward moving outpatient payments from a fee-for-service model to a true prospective payment system with a number of its proposals in the 2016 OPPS proposed rule (https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-16577.pdf), including new comprehensive APCs (C-APC) and extensive APC consolidation and reconfiguration.

September 1, 2015
Briefings on APCs

2016 OPPS proposed rule

September 1, 2015
Briefings on APCs

The 2016 OPPS proposed rule released July 2 is deceptively short, but packs a punch. CMS is proposing the most massive APC reconfiguration and consolidation of APC groups since the beginning of OPPS, says Jugna Shah, MPH, president and founder of Nimitt Consulting, based in Washington, D.C., and Spicer, Minnesota.

To get a real sense of the financial impact, providers will need to take several steps, says Shah. First, review the narrative text to get a feel for the major categories of changes CMS is proposing, including some of the operational ones.

July 21, 2015
Medicare Insider

This week’s note is about the 2016 OPPS proposed rule. Click the link above for more information and an in-depth analysis.

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