CMS' coding modifiers are not always used to report clinical components of a service. Sometimes they can be used in order to provide information about how a service relates to Medicare coverage policies.
As healthcare providers increasingly accept financial risk associated with patient management due to the transition from fee-for-service to risk-/value-based reimbursement, the traditional model of healthcare reimbursement has been flipped upside down.
The April 2016 I/OCE update brought a host of code and status indicator changes, as well as corrections to CMS' large January update that instituted policies and codes from the 2016 OPPS final rule.
CMS is expected next week to discuss potential changes to 2-midnight rule audits by Quality Improvement Organizations after quietly suspending the reviews in early May.
CMS recently released two July 2016 quarterly updates: Transmittal R3523, the July update to OPPS, and Transmittal R3524CP, the related July update to the integrated outpatient code editor (I/OCE). Hospitals are strongly encouraged to review both of these updates to obtain important guidance on the billing, processing, and payment of inpatient and outpatient hospital services covered under Medicare Part B.
This week’s updates include a survey and certification letter for the adoption of 2012 Life Safety and Health Care Facilities Code; the July 2016 updates to the Integrated Outpatient Code Editor and hospital OPPS; and more!
The addition of thousands of new diagnosis and procedure codes in a single year might typically be cause for concern for hospitals, with ICD-9-CM updates before the 2012 code freeze rarely topping more than a couple hundred per year.
Few in the healthcare industry would argue that the way the government currently pays for drugs is the most cost-effective, efficient, and equitable method possible.
