This week’s Medicare updates include new hospital appeals settlement options, revisions involving the addition and deletion of ICD-10-CM codes from certain NCDs, details on the partial settlement of a 2-Midnight policy court case, and more!
Currently, there are no national guidelines for how facilities should assign evaluation and management (E/M) levels in the emergency department (ED). Under Medicare’s ambulatory payment classification (APC) system, facilities create their own internal guidelines for determining the ED visit level, and each facility must follow its own system to demonstrate compliance.
A Comprehensive Error Rate Testing (CERT) study showed insufficient documentation causes most improper payments for arthroscopic rotator cuff repairs, according to the October 2017 Medicare Quarterly Compliance Newsletter.
The focus of FY 2018 code changes is specificity. Payers now expect codes to reflect the exact diagnosis and care given before claims will be reimbursed. Increased granularity in both clinical documentation and coding is critical for revenue cycle success in the year ahead.
This week’s Medicare updates include the OPPS, Quality Payment Program, End-Stage Renal Disease, and Medicare Physician Fee Schedule final rules; an announcement of the new Meaningful Measures initiative; a list of new Clinical Laboratory Improvement Amendments waived tests; and more!
This week's note reviews pre-service coverage analysis processes in light of the recent CMS decision to delegate the target, probe, and educate medical review strategy to the Medicare Administrative Contractors.
