This week’s Medicare updates include the implementation transmittal for the 2020 Medicare Physician Fee Schedule, two Special Edition MLN Matters articles on the implementation of the Patient-Driven Groupings Model, home health billing compliance information, and more!
Carolinas Hospital in Florence, South Carolina, received $431,757 in Medicare overpayments for incorrectly billed inpatient and outpatient services, according to an Office of Inspector General (OIG) audit report released November 26. Based on the sample, the OIG estimates the hospital may have received at least $3.4 million in overpayments.
Q: I'm told, although I'm not convinced, that our payment for Keytruda is denied by Anthem when we use ICD-10-CM code Z51.11 (encounter for antineoplastic chemotherapy) first followed by the code for cancer, i.e., C34.12 (malignant neoplasm of upper lobe, left bronchus or lung). I reviewed the coding guidelines again and that is our instruction. Does anyone have experience with this issue?
The application of attorney-client privilege is somewhat more complicated in situations where the client is a corporation. Although corporations are entitled to the same protection of confidentiality as noncorporate clients, the application of the privilege often turns on which corporate officials and employees sufficiently personify the corporation as a client.
Is your hospital doing enough to manage patients with diabetes both in the hospital and when they transition to the next level or care or to home? A recent survey of more than 600 people in 408 U.S. hospitals, finds that some hospitals might be falling short.
When voluntary disclosure for overpayments is an option rather than an obligation, the provider may encounter diverse opinions among its decision-makers. Some may express a desire to bring the potential problem to the attention of the government and attempt to resolve the matter quickly without incurring criminal penalties, civil fines, or exclusions.
