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?
In many companies, the compliance officer is the first to become aware of a potential compliance problem that could lead to civil or criminal liability. A best practice is to give the compliance officer the authority to conduct internal investigations.
In the 2020 Medicare Physician Fee Schedule (MPFS) final rule, CMS put a stamp of approval on its previous proposals to overhaul how medical practices will report office and outpatient E/M services in 2021.
The government is starting a trial program in the District of Columbia that aims to improve treatment for Medicaid beneficiaries struggling with serious mental illness or substance use disorders.
Frequent users of the emergency department are often also high users of other medical, social, and mental health services. This underscores the need for hospitals to address not only medical issues, but the behavioral health and social needs of patients, says a new analysis published in the November issue of Health Affairs.
