This week’s Medicare updates include an advisory opinion on whether an excluded individual could be employed by an entity involved in federal healthcare programs; a pair of fact sheets on the cost and advancing care information performance category policies for MIPS in 2018; a video for medical offices on the new Medicare cards; and more!
One of the most memorable sessions at the AMA CPT Symposium in November 2017 involved an impromptu open mic feedback session facilitated by CMS’ Marge Watchorn, deputy director of the Division of Practitioner Services. The focus of this session was the applicability of the current CMS documentation guidelines for E/M services.
In the current healthcare climate, the issue of medical necessity documentation, or lack thereof, is one of the most common reasons for claim denials. For a service to be considered medically necessary (by a third-party payer), it must be considered a reasonable and necessary service to diagnose and/or treat a patient’s current and/or chronic medical condition.
In the 2018 OPPS final rule, CMS finalized a change to the current clinical laboratory date of service policies for outpatient molecular pathology tests and advanced diagnostic laboratory tests.
CMS, the Veterans Health Administration, and some states measure our care quality based on risk-adjusted readmission rates after inpatient admissions. In fact, up to 3% of our hospital’s Medicare inpatient revenue (used to pay physician subsidies) is at risk if we don’t manage our patients’ readmissions in concert with Medicare’s algorithms.
In advance of ICD-10-CM/PCS, many institutions implemented computer-assisted coding (CAC) hoping to mitigate the anticipated productivity losses, but research has confirmed suspicions that there is an inverse relationship between coding productivity and accuracy.
