Q: We have claims that are hitting an edit between a procedure HCPCS code and the new codes for moderate sedation (99151–99153). Since moderate sedation is no longer inherent in any procedure beginning January 1, why are these scenarios hitting an edit?
This week’s Medicare updates include the delay of the effective date of the Advancing Care Coordination Through Episode Payment Models; Cardiac Rehabilitation Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model; a quarterly update to the Medicare Physician Fee Schedule database; ICD-10 coding revisions to National Coverage Determinations; and more!
Discharge planning, which is integral to providing continuity of care, is a dynamic process. The steps of discharge planning sometimes occur in order, they sometimes overlap, and they sometimes move back and forth.
As hospitals get ready to start notifying patients about their status under the requirements of the NOTICE Act using the MOON form, many still have questions about the process and the form itself. The NOTICE Act requires hospitals to provide a verbal and written notice (using the MOON form) of outpatient status to any patient who has been in observation for more than 24 hours. The hospital must provide notice to the patient within 36 hours of the start of the service, or at the time of discharge or inpatient admission. “The notice must be provided no later than 36 hours after observation services are initiated or, if sooner, upon release,” according to CMS.
Q: If we receive a release of information request from an attorney on behalf of a patient, is it acceptable to respond to the request without seeking verification from the patient on whose behalf the information is being requested?
This week’s Medicare updates include Advance Care Planning implementation for OPPS claims, revision to State Operations Manual Appendix PP - incorporating revised Requirements of Participation for Medicare and Medicaid certified nursing facilities, and more!
Copying and pasting information in electronic health records (EHR) increases errors and makes it difficult for clinicians to determine what information is relevant, according to a report from the National Institute of Standards and Technology (NIST) released in January.
Looking to get an ACM™ certification? In December, the American Case Management Association (ACMA) and National Board for Case Management (NBCM) announced a change to the exam eligibility requirements that may be of interest to those looking to earn ACM certification. The NBCM now allows applicants with at least one year of full-time supervised work experience to sit for the ACM-RN (Registered Nurse) and ACM-SW (Social Work) exams. Prior to this change, candidates had to have at least two years of case management experience before they could take either exam.
