When it comes to dealing with Medicare Recovery Auditors (RACs), there is never a dull moment for HIM professionals. Any shift in the RAC program quickly emerges as front-page news for HIM leaders.
This week's note discusses the order and certification requirement for critical access hospitals (CAH), including the proposal in the FY 2018 IPPS proposed rule to reprioritize the review of CAH inpatient admissions.
This week’s Medicare updates include a clarification of medical reviews of hospital claims for Part A payment, two new “K” codes for therapeutic continuous glucose monitors, The July 2017 quarterly HCPCS Drug/Biologicals code change update; and more!
Reimbursement for provider-based departments (PBD) can be complex, and regulations affecting it have changed frequently over the past year. Section 603 of the Bipartisan Budget Act of 2015, the 2017 outpatient prospective payment system (OPPS) final rule, and the 21st Century Cures Act changed the payment methodology and made multiple adjustments to the definition of excepted (on-campus or grandfathered off-campus) and non-excepted (off-campus) PBDs. Hospitals must know the regulations inside and out and understand how they apply to their PBDs and to avoid denials or noncompliance.
This week’s Medicare updates include new CLIA waved tests, changes to the payment policies for Reciprocal Billing Arrangements and Fee-For-Time Compensation Arrangements (formerly “Locum Tenens Arrangements”), implementation of modifier -CG for Type of Bill 72x, and more!
