In recent years, the Office of Inspector General (OIG) has taken aim at case managers and discharge planners who violated federal anti-kickback statutes—specifically those who took items or payments in exchange for post-acute referrals.
Medicare beneficiaries who took part in telemedicine visits during the pandemic were more likely to stick with medication therapies to treat their opioid use disorder (OUD) and less likely to experience a drug overdose, according to a JAMA Psychiatry study.
In August, the Office for Civil Rights (OCR) announced a settlement with New England Dermatology P.C., known as New England Dermatology and Laser Center, over the improper disposal of PHI, which is a potential HIPAA Privacy Rule violation.
Effective October 1, the ICD-10-CM code set will be updated to include over 1,100 new codes before counting code revisions and deletions. This article covers new codes for musculoskeletal and genitourinary conditions including muscle wasting, rib and sternal fractures, drug-induced neuropathy, and endometriosis.
A report released last month by the American Hospital Association (AHA), called Commercial Health Plans’ Policies Compromise Patient Safety and Raise Costs, found that not only is the cost of private health insurance raising affordability issues for American consumers, but policies, such as prior authorization requirements, may increasingly be putting patients at risk and driving up hospital administrative costs.
The 3-day payment rule is known to coders by various names such as the 72-hour rule, the 3-day payment window, or MS-DRG window policy. Kimberly Lee M.Ed., RHIA, CCS-P, describes how to navigate the rule’s nuances for billing purposes.
The 2023 CPT update will shift provider consults, facility, and home-based E/M visits to a coding model based on medical decision-making (MDM) or time, according to the AMA.
Every organization’s priorities will differ, but any outpatient CDI program must determine how to measure the improvement associated with its efforts. Outpatient CDI will directly contribute to the facility’s overall quality performance and risk adjustment models.
Coding managers should not assume that they can review every coding guideline, Coding Clinic, or coding-related issue targeted by the Office of Inspector General. Review considerations for conducting focused internal and external audits.
JayHodes, president of HIPAA compliance company Colington Consulting in Burke, Virginia, sees eight specific challenges organizations face when trying to comply with HIPAA regulations.
