The American Hospital Association and several other hospital groups released a joint statement criticizing CMS’ proposed price transparency policy outlined in the calendar year 2020 OPPS proposed rule that would require hospitals to publish negotiated rates with private payers.
Q: A diabetic patient is diagnosed with a gangrenous decubitus ulcer of the left heel and admitted to the hospital for treatment. If the provider documents an association between diabetes and the decubitus ulcer, which condition should be sequenced as the principal diagnosis?
While there are many conferences that touch upon aspects of revenue integrity, RIS is the only one entirely dedicated to the topic. Plus, it is a great way to meet other professionals in the field of revenue integrity who are facing similar challenges and have similar interests.
CMS is proposing several revisions to its clinical diagnostic laboratory date of service (DOS) policy in the FY 2020 OPPS proposed rule, including requiring ordering physicians to determine whether tests are intended to guide treatment during a current or future outpatient encounter.
Q: We have a case in which there was an observation order for a patient with Medicare Part B as a primary insurance and Cigna as a secondary insurance. If this is billed to Medicare and denied, can the secondary insurance be billed?
Q: Suppose a patient comes in for psychological testing evaluation. The provider interprets the test results and patient data, prepares a report, and begins treatment planning. If the interactive feedback session is held several days later, how would this be reported using CPT codes?
CMS released the 2020 OPPS proposed rule July 29, proposing to refine previous policies related to price transparency and the 2-midnight rule, while also asking for comments on how to potentially undo its policy that reduced payments for drugs purchased under the 340B drug discount program by nearly 30%.
CMS recently announced that it updated the national coverage policy for transcatheter aortic valve replacement (TAVR), requiring covered hospitals and physicians to begin or maintain a TAVR program and adhere to updated volume requirements.
