The AMA revamped coding for molecular pathology beginning in 2012 and continuing in the 2013 CPT ® Manual. Now CMS is trying to determine how to pay for those tests and the agency wants to hear from providers.
CMS is reexamining inpatient criteria because it has seen a significant increase in the number of patients spending more than 24 hours in observation. Providers are worried that a Recovery Auditor will deny a short inpatient stay for lack of medical necessity and recoup payment years later. So instead, some facilities place patients in observation for longer time periods.
Q. If an organization’s human resources officer is also the plan administrator for the organization’s group health plan (self-insured), does that individual have the right under HIPAA to access records of high-dollar pharmacy/medical claims for the purpose of targeting the insured for wellness programs or other alternative treatment plans?
