This week’s updates include a notice of proposed rulemaking for bundled payment models for high-quality, coordinated cardiac and hip fracture care; FY 2017 rate update for inpatient psychiatric facilities PPS; and more!
Q: I have been told by our billers that infusion codes reported in the ED along with an E/M code that has modifier -25 (significant, separately identifiable evaluation and management service on the same day of the procedure or other service) require another modifier. Have I missed an update somewhere along the way?
The Office for Civil Rights released HIPAA phase two guidance July 27. The guidance, a document linking specific audit protocols with document submission requests, included the slide deck from a July 13 webinar for covered entities selected for desk audits, and a list of questions and answered asked during the webinar and via email.
In the 2017 OPPS proposed rule, CMS is proposing to continue its comprehensive APC (C-APC) policy first implemented in 2015 and has proposed 25 new C-APCs for 2017 in addition to the existing 37 C-APCs.
An Oregon academic health center agreed to a $2.7 million HIPAA violation settlement fine and corrective action plan (CAP) after a breach investigation revealed serious HIPAA vulnerabilities throughout the organization, HHS said in a statement released July 18.
When it comes to providing high-quality patient care, most American hospitals simply don’t. That’s if the recent round of five-star rankings from CMS are to be believed. About 1,700 hospitals (39%) earned just three out of five stars, an “average” rating, FierceHealthcare reported.
If a Medicare patient is downgraded from inpatient to observation is it expected that the patient will be issued the MOON and condition code 44 will be used on the claim?
Q: When our pharmacy mixes medications for infusion, they sometimes have to waste a part of the vial that was opened. They log this in the pharmacy log, which they keep in the department. We have been billing the full amount of the drug that was in the vial and have had no issues with getting paid. Our pharmacist came from a regional meeting and told us that this is going to change.
