Managers should not assume that they can review every guideline, every item in Coding Clinic, or every coding-related issue targeted by the OIG or Recovery Auditors. However, those issues that have been identified as the result of denials, external coding audits, or quality initiatives should surface to the top of the audit list for the coding manager.
Q: A payer has begun denying authorization for admissions and diverting patients from our hospital to one of our competitors, even when our hospital is closer. Is this a common practice among payers? What language should we add to the contract to discourage it?
Several national groups representing accountable care organizations and physicians expressed concern that CMS has delayed disbursement of the 5% advanced alternative payment model (APM) bonus.
This week’s Medicare updates include an OIG review of emergency ambulance transports from hospitals to skilled nursing facilities, revisions to the State Operations Manual regarding critical access hospitals adding provider-based locations, coding revisions for national coverage determinations, and more!
