This week’s updates include Critical Access Hospital (CAH) Recertification Checklist for evaluation of compliance with the location and distance requirements; core quality measures collaborative release; and more!
CMS won’t release guidance on the payment impact of Section 603 of the Bipartisan Budget Act of 2015 until the 2017 OPPS proposed rule, but the American Hospital Association (AHA) has weighed in with a letter to Congress urging the government to reject further site-neutral payment policies.
Q: I have a follow-up question to last week’s answer about lab payments. We should receive payment for a lab-only claim because of the new Q4 status indicator. However, we noticed that sometimes we do and sometimes we don’t. The difference seems to be when we report a venipuncture and when we report the blood being drawn from a ventricular assist device (VAD). When the venipuncture is reported, we get paid for all line items. When the blood draw is from a VAD, we don’t get paid for the lab work. Is this correct?
Medicare continually seeks to expand access to certain basic health care services, particularly for beneficiaries located in remote areas of the country.
This week’s updates include identifying "No Documentation" medical necessity denials for claims flagged for Recovery Auditor review; Shared System Enhancement 2015 Analysis and Design HUOPCUT hospice period and Health Maintenance Organization processing; and more!
Q: If we're not using condition code W2 but we're billing on the type of bill (TOB) 121 after we received a denial, are we paid less than if the W2 would have been used?
Three years after publishing a notice of public rulemaking requiring hospitals to report Medicare overpayments to CMS, the agency finalized a rule that makes significant concessions to providers, but still requires a six-year lookback period.
The government may finally have to comply with its congressionally mandated deadlines for reviewing claims at the Administrative Law Judge level after a federal appeals court this week reversed a lower court’s dismissal of a lawsuit brought by hospitals.
