Organizations and CDI specialists must have a thorough understanding of how regulations and guidelines impact risk adjustment in the outpatient setting. A misinterpretation can easily lead to inadvertent upcoding—and that can lead to costly audits, settlements, and accusations of fraud.
CMS recently released guidance on submitting claims and filing appeals as it rolls out its new Medicare cards. The new cards will replace the Health Insurance Claim Number, which is based on the beneficiary’s Social Security Number (SSN), with a Medicare Beneficiary Identifier that is not tied to the beneficiary’s SSN.
This week’s Medicare updates include new skilled nursing facility advance beneficiary notice forms, the 2019 Advanced Notice for Medicare Advantage and Part D plan changes, quarterly HCPCS drug/biological code changes, and more!
High-risk opioid users are less likely to get a disproportionate quantity of opioid prescriptions from the emergency department than they are at an office visit, according to a recent study in Annals of Emergency Medicine.
HIPAA lays out specific requirements for breach response and reporting. Although most organizations might understand these requirements in theory, compliance is often tricky in practice.
