News

CMS’ introduction of CMS-1455-R in March 2013 allowed hospitals to ignore the one-year timely filing deadline and rebill admissions that were denied by an auditor, even many years after the date of service. Fast forward to October 29, 2015, when the OIG released a policy stating that hospitals may waive the cost of self-administered medications to Medicare beneficiaries without concern about inducement or kickback accusations if the hospital develops a policy and applies it uniformly.

CMS’ proposed changes to implement Section 603 of the Bipartisan Budget Act of 2015 and reshape payments for off-campus, provider-based departments represent the most significant changes in the current year 2017 OPPS proposed rule. 

A data breach at a Phoenix anesthesiology and pain clinic affected 882,590 patients as well as all current and former employees and providers.

CMS recently posted a fact sheet about the Diabetes Prevention Program, a new benefit discussed in the 2017 Medicare Physician Fee Schedule proposed rule. Questions remain about the implementation of this program.

This week’s Medicare updates include a Multiple Procedure Payment Reduction on the Professional Component of certain diagnostic imaging procedures; a new condition code to use when hospice recertification is untimely and corrections to hospice processing problems; and more!

Q: In my facility, we are supposed to send an email to our physician advisor (PA) and to administration if a query is not answered within a week. However, this policy doesn’t work well because administration does not do anything with that information, and the PA doesn’t have time to review unanswered queries. Do you have any suggestions concerning when to let a query go unanswered?

The growing consumer health app and wearable device market poses a significant threat to the privacy and security of protected health information (PHI) and Congress must act to close policy gaps, the Office of the National Coordinator of Health IT (ONC) said in a recent report.

CMS has proposed several changes for status and comment indicators in the 2017 OPPS proposed rule in an attempt to better identify codes and services for providers. 

I was under the impression that CMS said it would leave the billing for self-administered drugs to the OIG. However, we have not heard anything from the OIG. What if we are not billing for the medications?

The August 2 issue of Revenue Cycle Daily Advisor included a question about benchmark conversion rates from observation to inpatient status. With regard to that question, I think it may be helpful to know the average national conversion rate and average rate for critical access hospitals. Do you have that information?