CMS recently announced that it is accepting comments until November 29 on a proposal to collect acquisition cost data from hospitals participating in the 340B drug discount program.
Q: Our coding team saw that there is a new section for radiation therapy in the FY 2020 ICD-10-PCS Official Guidelines for Coding and Reporting. Can you explain the recent changes made to this section?
CMS’ proposal in the 2020 OPPS proposed rule mandating the disclosure of negotiated charges between hospitals and payers may exceed the agency’s legal authority, the American Hospital Association (AHA) stated in its comments on the proposed rule.
Q: A payer has begun denying authorization for admissions and diverting patients from our hospital to one of our competitors, even when our hospital is closer. Is this a common practice among payers? What language should we add to the contract to discourage it?
Q: The 2020 ICD-10-CM update added several new codes for legal interventions. What are these codes, and can they be assigned based on nonphysician documentation?
Several national groups representing accountable care organizations and physicians expressed concern that CMS has delayed disbursement of the 5% advanced alternative payment model (APM) bonus.
Preliminary findings released by the Massachusetts Health Policy Commission (HPC) show that maximized coding may have increased statewide commercial spending for inpatient services by nearly 11% between 2013 and 2018.
Q: We recently had a patient who was admitted with sepsis and the physician documented sepsis, a urinary tract infection (UTI) related to a chronic Foley catheter, and pneumonia. Can we report sepsis first instead of the complication code, or is the complication always first?
