Affording prescription drugs can be a challenge for many patients. Even for patients with insurance, cost sharing and copays can add up. To head off these potential problems, case managers are often tasked with identifying affordability issues and finding solutions for patients to help ensure they can comply with discharge recommendations.
This week's note from the instructor is the second article in a series reviewing the coverage, billing, and payment rules for swing bed services. This edition of the series focuses on professional services related to swing beds as well as applicable billing and payment rules for swing beds in critical access hospitals (CAH) and non-CAH small rural hospitals.
Q: I work for a hospital with a geriatric psychiatry unit. Many patients are discharged to nursing homes. Often, nursing homes contact the hospital for patient information, but we have only the patients' psychiatric records and are hesitant to send them. Is it permissible under HIPAA to send this information to a nursing home for continued care?
Success under MACRA relies on the capture and maintenance of trustworthy clinical and financial patient data sets. HIM professionals understand root cause analysis, the mechanism of reporting data, and the importance of data consistency and integrity.
CMS recently clarified the use of modifier -KX (requirements specified in the medical policy have been met) in response to an Office of Inspector General report that identified conflicting guidance that resulted in $4.6 million in improper payments.
