In the current healthcare climate, the issue of medical necessity documentation, or lack thereof, is one of the most common reasons for claim denials. For a service to be considered medically necessary (by a third-party payer), it must be considered a reasonable and necessary service to diagnose and/or treat a patient’s current and/or chronic medical condition.
A recent report released by the Centers for Disease Control and Prevention revealed that almost 70% of Americans are considered overweight or obese. This epidemic costs American healthcare systems approximately $190 billion per year in treatment of weight-related conditions.
CMS' Bundled Payments for Care Improvement Advanced model will qualify as an Advanced Alternative Payment Model under the Quality Payment Program and include outpatient episodes.
The National Association of Healthcare Revenue Integrity is currently seeking speakers to present at the 2018 Revenue Integrity Symposium, to be held October 16–17, 2018, in Litchfield Park, Arizona. Is that special person you or a colleague?
CMS' 340B FAQ reviews modifiers -JG (drug or biological acquired with 340B drug pricing program discount) and -TB (drug or biological acquired with 340B drug pricing program discount, reported for informational purposes) and requires 340B hospitals to report modifiers even on drugs that are not subject to the discount policy.
CMS’ policy in the 2018 OPPS final rule to cut reimbursement for drugs purchased through the 340B drug discount program by nearly 30%, accounting for the decrease from average sales price plus 6% to minus 22.5%, is getting a lot of attention from the provider community—and with good reason.
The 2018 OPPS final rule, published in the Federal Register on November 13, has two changes that could affect case managers—the removal of the total knee replacement from the inpatient-only list and cuts to payments for drugs purchased through the 340B drug discount program.
CMS is moving forward with its plan to drastically cut payments for drugs acquired through the 340B drug discount program, according to the 2018 OPPS final rule, released in November.
Effective January 1, 2018, Medicare payments for X-rays taken using computed radiography will be reduced by 7%, according to a policy CMS finalized in the 2018 OPPS final rule. This reduction will remain effective until 2022, and increase to 10% beginning in 2023, as required by paragraph 1848 (b)(9) of the Social Security Act.
U.S. District Court Judge Rudolph Contreras will hold a hearing December 21 for a lawsuit aimed at halting the CMS payment reduction for hospital outpatient drugs acquired through the 340B program, a policy set to go into effect January 1.
