News

Findings from a Comprehensive Error Rate Testing (CERT) study show that insufficient documentation caused most improper payments for chiropractic services billed to Medicare in 2018, according to the July 2019 Medicare Quarterly Compliance Newsletter.

Q: How can we ensure key staff are kept up to date on commercial payer changes?

The New York City Fire Department (FDNY), which operates ambulances, disclosed in August that 10,253 patients treated or transported by the FDNY from 2011 to 2018 may have had their protected health information (PHI) compromised after an external hard drive containing unencrypted data went missing in March, according to an FDNY press release.

Q: A patient presents to a wound care clinic for assessment of a 15 sq. cm open wound. A nurse evaluates the wound for size, depth, and evidence of inflammation and performs sharp selective debridement. Would it be appropriate to bill an E/M code and if so, should we report modifier -25?

Q: Is there anything that a hospital needs to do regarding HIPAA and the confidentiality of famous patients? Obviously employees shouldn’t snoop, but can you recommend any added protections?

Q: What are some examples of programs that address social determinants of health (SDoH) in an Accountable Care Organization (ACO) setting?

Chimeric antigen receptor T-cell (CAR-T) therapy will be covered for Medicare beneficiaries nationally, according to an August 7 CMS press release.

Oversight of the practice of case management is a complex process. A number of moving parts must be factored in, including education, credentialing, and professional qualifications.

Q: What is the difference between a Medicare claim appeal (redeterminiation) versus reopening of a claim?

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.