The Patient-Driven Payment Model (PDPM) has so many nuances that can impact reimbursement that it is near impossible for SNFs to consider and capitalize on them all. Check your processes and procedures to ensure you’re taking advantage of or protecting against the following aspects of PDPM.
An August report from the Office of Inspector General (OIG) found that Oceanside Medical Group, a clinic providing mental health services in Santa Monica, California, received $2.6 million in overpayments for psychotherapy services by failing to comply with Medicare billing and documentation requirements.
Q: Does a psychiatrist need to document a physical examination and a review of prescriptions in order to support the reporting of CPT code 90792 (psychiatric diagnostic evaluation with medical services)?
Q: HHS has a proposed rule out that would make sharing of health information to patients easier through the use of APIs and smartphones. What’s important to know for making these apps secure as we work with vendors who will ultimately be producing these apps for a covered entity?
Along with its annual updates to the inpatient-only list, the 2020 Outpatient Prospective Payment System (OPPS) final rule finalized a proposal that will give hospitals a grace period to adjust internal policies for procedures recently removed from the inpatient-only list.
The Office of the National Coordinator for Health Information Technology (ONC) and the Office for Civil Rights released version 3.1 of the HHS Security Risk Assessment (SRA) Tool, designed to help healthcare providers conduct security risk assessments.
CMS is moving forward with multiple policies—effectively based on reducing reimbursement to hospitals—that have been deemed unlawful in court, according to the 2020 OPPS final rule, released Friday, November 1. However, the agency pushed its controversial price transparency proposals to a separate, yet-to-be released final rule.
Q: How should we handle denied claims when the payer refuses payment under the billed status? Do we need to document that the status was changed only because the payer did not agree to any other options?
