The shift from fee-for-service to value-based programs for outpatient payment systems has increased the need for outpatient CDI staff to review documentation for pertinent clinical factors.
Many hospitals find that their Patient Safety Indicator (PSI) ratios remain high despite doing a spectacular job of addressing these events and exclusions. That may be because they fail to realize that the Agency for Healthcare Research and Quality has a risk-adjustment methodology that predicts each of these PSIs and is dependent upon the documentation and coding of PSI-sensitive risk factors.
This week’s Medicare updates include a special edition MLN Matters article on billing requirements for OPPS providers, an updated OIG work plan, a final decision memo for an NCD on genetic testing for cancer patients, and more!
In today’s uncertain regulatory environment, establishing an internal audit process is more important than ever to ensure proper billing and reimbursement. Follow these eight steps to establish an efficient internal audit and compliance program.
Changes to HCPCS and CPT® codes, drug and biological payments, and a new separately payable procedure code are coming in April. The transmittal announcing the updates also includes clarification on the application of the modifier –FY payment reduction.
Coding and documentation can make or break providers’ success under the Quality Payment Program. An examination of specific measures reveals coding and documentation areas to focus on.
