Last week, CMS released MLN Matters article MM8572 with billing instructions for laboratory services paid under either OPPS or the Clinical Laboratory Fee Schedule (CLFS). Prior to this guidance, I had received several questions from clients and past students regarding rural sole community hospital (SCH) add-on payments for lab services. Click the link above for more information and an in-depth analysis.
In July 2013, Medicare Administrative Contractors (MACs) began to recover overpayments on Annual Wellness Visit (AWV) claims with dates of service on and after January 1, 2011 that were processed by Medicare on and after April 4, 2011 through March 31, 2013 (see MLN Matters® Article #8153). It was subsequently determined that both the professional and technical components of Method II critical access hospital (CAH) claims had been identified as overpayments and recouped in error. Method II CAHs are entitled to payment for the professional components of these claims.
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.
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