Courtesy of the prevalence of traumatic brain injuries in the military and across sports, this diagnosis has hit the mainstream, and case managers are challenged by a vast range of circumstances and factors they must take into consideration.
Provider participation in the BPCI Advanced program fell by 16% between October 1, 2018, and March 1, 2019, at the initiation of the risk-bearing phase of the voluntary payment program. Overall participation includes nearly 1,300 providers still participating, according to CMS.
CMS released a bulletin April 10 on behalf of HHS seeking providers to participate in a volunteer Provider Pilot Program to test the process for reviewing compliance with its HIPAA Administrative Simplification rules.
Q: I’m a benefits administrator, and I got a call from human resources about an email she received from an employee about a procedure performed by her physician that was not covered by her insurance. Can I discuss the case with human resources? Or should I talk directly to the employee?
Representatives from CMS and the Office of Inspector General (OIG) discussed hot topics and focus areas at HCCA's 2019 Compliance Institute in Boston, including developing interactive documentation checklists, potential changes to Stark Law this year, and methods to address the high rate of coding and documentation errors on inpatient rehabilitiation facility (IRF) claims.
The American Medical Association (AMA) and UnitedHealthcare announced a collaboration to better address social determinants of health (SDoH) by standardizing how this data is collected and processed through the creation of new ICD-10 codes related to SDoH.
CMS finalized changes to NCCI Medically Unlikely Edits (MUE) and procedure-to-procedure (PTP) edits in its quarterly update to NCCI edit files, effective April 1.
Q: An investigator from the state health department called the clinic where I work and asked for health records to collect vaccination data for a public health project. Is it a HIPAA violation to share that data?
