News

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.

There are two newly approved Recovery Auditor issues.

Q: We have started using what our physicians call “high-frequency” neurostimulators. I know there are two HCPCS codes for reporting these to Medicare, but how do we know what is high frequency and what is not?

This week’s updates include a transmittal regarding completing and processing Form CMS-1500 Data Set; a transmittal from Provider Reimbursement Manual, Part 1–Chapter 31 on Organ Acquisition Payment Policy; and more!