Findings from a December Office of Inspector General (OIG) report show that CMS based an estimated $2.7 billion in risk-adjusted payments on chart review diagnoses that Medicare Advantage organizations (MAO) didn’t link to specific services. Their findings highlight concerns about the validity of payment data submitted to CMS.
Q: What is the process for submitting a claim for an inpatient hospitalization when our utilization review committee determined after discharge that the inpatient admission was not medically necessary?
Q: Our coding department was told there were changes made for fiscal year (FY) 2020 when it comes to reporting healed/healing pressure ulcers and pressure-induced deep tissue damage. Can you explain any recent updates?
The Transparency in Coverage Proposed Rule comment period has been extended from January 14 to January 29, CMS announced. The proposed rule would require insurers to provide personalized price estimates and publish negotiated in-network rates and historical payment information.
Q: Our facility sees a lot of patients dealing with diabetes and diabetic complications. Do you have any advice for helping these patients during their stay or after discharge?
In an effort to increase the medically appropriate use of transitional care management (TCM) services, CMS increased payment and removed billing restrictions for TCM services, as outlined in the 2020 Medicare Physician Fee Schedule (MPFS) final rule.
Q: I’ve heard conflicting information about reporting uncertain diagnoses. Do the ICD-10-CM diagnoses need to be documented in the discharge summary/final progress note or can they be coded from an earlier progress note?
Q: If a patient is requesting his medical records via email, so long as our email is encrypted and secure, can we send it? We only have his email on his admission papers, which matches the email address he sent to us.
