CMS may have overpaid hospitals, physicians, and freestanding facilities almost $270 million for polysomnography services that did not meet Medicare requirements over a two-year period, according to an Office of Inspector General report.
Q: Our clinical trial claims often hit edits for missing drugs or devices when those are supplied by the trial sponsor and we can't bill for them. We've been manually reviewing these edits. Is there a recommended method for handling these types of edits that's more efficient?
Medical Informatics Engineering, Inc., an Indiana-based medical records service has agreed to a $100,000 settlement with OCR and a $900,000 multi-state settlement with 16 state attorney general offices for a HIPAA breach that compromised the protected health information of approximately 3.5 million people.
Q: We have a patient who received a pancreas transplant for the treatment of diabetes. The patient was later admitted to the hospital for treatment of an unrelated kidney stone. Would I still need to assign the ICD-10-CM code for diabetes as a chronic condition based on the patient’s medical history?
Commercial and government payers track chronic conditions using Hierarchical Condition Category (HCC), and providers can track HCCs to better monitor and project reimbursement and compliance.
