News

Providers, clinic staff, billing entities, and patients continue to struggle with new reporting requirements for rural health clinics six weeks since the implementation. Read for an expert's analysis of the most recent information CMS has distributed on the requirements.

Q: Are there any new HCPCS codes for recently released biosimilar products on the horizon? Our physicians and pharmacists are being contacted by the manufacturer about purchasing and using them, but we want to be sure we can report them appropriately.

This week’s updates include a special edition MLN Matters article regarding rural health clinics HCPCS reporting requirement and billing updates; the Merit-Based Incentive Payment System and Alternative Payment Model Incentive under the Physician Fee Schedule publication in the Federal Register; and more!

CMS recently released its seventh maintenance update for National Coverage Determinations to incorporate ICD-10 and other coding updates, which may require providers to contact Medicare Administrative Contractors regarding previously submitted claims.

Q: How should hospitals report bedside procedures?

America’s Essential Hospitals (formerly known as the National Association of Public Hospitals and Health Systems) is starting an initiative to better understand and improve population health programs.

On April 29, CMS released a transmittal and MLN Matters article regarding use of JW modifier for drug wastage. The transmittal states that, effective July 1, claims for discarded drug or biological amounts not administered to any patient, shall be submitted using the JW modifier. Also, effective July 1, providers must document the discarded drugs or biologicals in patient's medical record.

There are three newly approved Recovery Auditor issues.

This week’s updates include a revision of the method to calculate the length of stay edit for continuous invasive mechanical ventilation for greater than 96 consecutive hours; an update to the Fiscal Intermediary Shared System to make payment for drugs and biologicals services for OPPS providers; and more!

Q: If a physician orders a consultation for a patient who is experiencing a headache due to hypertension, which ICD-10-CM codes would be assigned? Would hypertension be coded since headache is a common sign and symptom of hypertension, or would both the headache and hypertension be coded?