A new effort is underway to allow observation stays to count toward the three-day stay required by CMS to qualify for reimbursement for a postacute skilled nursing facility stay.
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.
Section 216(a) of the Protecting Access to Medicare Act of 2014 (PAMA) added a requirement that will dramatically revise the Medicare Clinical Laboratory Fee Schedule (CLFS) effective January 1, 2018.
Mastering hierarchical condition categories (HCC) is key to success under new reimbursement methodologies that rely on risk-adjustment, quality, and value metrics such as the Quality Payment Program (QPP). Organizations need to take a close look at their training and audit programs to ensure that valuable information isn’t being left out of documentation—and negatively impacting HCC scores.
Patient care continues to move from the inpatient setting to outpatient. With this change, the challenge of securing comprehensive documentation that articulates the services rendered and the patient care provided now needs to extend across the care continuum.
