In the OPPS proposed rule, CMS had proposed to do away with the device to procedure and procedure to device edits. While this may seem like a provider friendly change, in fact, these edits have ensured that all costs, including the costs of all devices used, are billed by providers. This in turn ensures they are taken into account in rate setting, because CMS uses providers’ billed charges as a proxy for cost in setting future rates. Click the link above for more information and an in-depth analysis.
CMS issues certain quarterly updates relating to hospital outpatient services.These updates are primarily issued in the form of two recurring update notification transmittals (RUN).The first of these is a quarterly update to the IOCE Specifications. The second is a quarterly update to the Outpatient Prospective Payment System (OPPS). Because the most significant outpatient hospital changes become effective as of the beginning of each calendar year, the January updates are particularly important.Click the link above for more information and an in-depth analysis.
The number of patients using Medicare Advantage (MA) is rapidly growing, making Hierarchical Condition Categories (HCCs) an increasingly important concept for revenue cycle staff to understand in order to guarantee reimbursement.
Our experts answer questions on port reassessment, laparoscopies, reporting multiple biopsies, rejected drug claims, post-reduction film, nipple revisions, and more.
