News

Q: What should the utilization review committee look for when an inpatient stay is less than two midnights?

Q: What should case managers do when a patient lacks decision-making capacity but has no guardian or power of attorney?

Major changes in rural health clinic billing requirements has created significant problems processing those claims. Read an expert's take on the current issues facing rural health clinic revenue professionals.

There are four newly approved Recovery Auditor issues.

Q: Our pharmacy is asking if there is going to be payment for a new anti-hemophilia factor called Nuwiq. They say it is quite expensive and they want to know if there is additional payment for it.

This week’s updates include the fiscal year 2017 IPPS proposed rule; implementing payment changes for Frontier Community Health Integration Project; and more!

CMS issued the fiscal year (FY) 2017 IPPS proposed rule yesterday with updates to several quality initiatives and a reversal of the agency’s 0.2% payment reduction instituted along with the 2-midnight rule in the FY 2014 rule.  

Q: What elements must be included for inpatient certification?

Q: What are some questions case managers can ask during the screening process?

There are new enforcement editing requirements regarding the coverage and billing of Partial Hospitalization Program services, likely due to significant problems with these claims and coding highlighted in the 2016 proposed and final OPPS rules.