This week’s release of the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APM) proposed rule outlines CMS' specific plans for physician payments, pushing forward with its goal to increase value-based payments and unifying its varied quality, value, and EHR programs.
On March 31, CMS released special edition MLN Mattersarticle SE1607 regarding new enforcement editing requirements for the Medicare Benefit Policy Manual (Internet-Only Manual 100-02), Chapter 6, section 70.3, which describes coverage and billing of Partial Hospitalization Program (PHP) services. This guidance is likely due to the significant problems with PHP service claims and coding highlighted in the 2016 proposed and final OPPS rules. This guidance is effective for PHP services furnished on or after July 1.
The Provider Roundtable, established in 2003 to give CMS the benefit of providers' input and guidance on critical healthcare delivery issues, has issued a call for new members who have a strong interest in improving Medicare reimbursement under various payment systems.
This week’s updates include reporting principal and interest amounts when refunding previously recouped money on the Remittance Advice; Changes to the laboratory NCD edit software for July 2016; and more!
The new modifier -PO (services, procedures, and/or surgeries furnished at off-campus provider-based outpatient departments [PBD]) and the alternative payment provisions under the Bipartisan Budget Act Section 603 are both related to off-campus PBDs but define "off-campus PBD" slightly differently.
In February 2016, just four months after ICD-10 go-live, sister publication HIM Briefings (formerly Medical Records Briefing) asked a range of healthcare professionals to weigh in on their productivity in ICD-9 versus ICD-10.
A bipartisan coalition of more than two dozen members of the House of Representatives sent a letter to CMS this week asking for a delay in massive proposed changes to the Clinical Laboratory Fee Schedule due to begin January 1, 2017.
The April Integrated Outpatient Code Editor had a large volume of clarifications and changes to correct issues with processing claims related to new policies adopted in January. This article will explain when organizations can reprocess claims that were negatively affect by the edits.
Q: I have a question regarding which place of service (POS) code I should use for an orthopedic doctor who did a consultation on a patient that came through the ED. The patient has a spiral fracture of the humerus. The electronic record documents that the patient was admitted to the medical unit on January 31 but was a “boarder” in the ED until February 2, waiting on a room to be available. The orthopedic doctor saw the patient on February 1. The patient did finally receive a room assignment on February 2. In this scenario would I use POS 22 (outpatient hospital) or 23 (ED)? This patient has Medicare.
