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.
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!
As federal agencies release new and complex regulations for acute and postacute care facilities, providers are faced with the daunting task of unraveling and complying with the latest changes while ensuring patients receive quality care.
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 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.
