Inappropriate use of nonemergency ambulance transport cost Medicare $8.7 million in overpayments, according to a recent Office of Inspector General (OIG) report.
Back in January, I wrote an article regarding E/M codes and the need for changes to the 1995 and 1997 E/M documentation guidelines. In that article, I suggested making E/M codes for office visits solely time-based to simplify the reporting of these very subjective codes. Little did I know that this is what CMS would propose months later.
The National Center for Health Statistics recently released the 2019 ICD-10-CM Official Guidelines for Coding and Reporting, effective October 1, which include updated language and added specificity for classifying diagnoses.
CMS did not propose any new comprehensive APCs (C-APC) last year, taking a rare year off, but it did introduced three new C-APCs in the 2019 OPPS proposed rule, released in late July.
CMS’ 2019 OPPS proposed rule continues the agency’s efforts to enforce site-neutral payments and reduce drug payments by introducing policies to reduce reimbursement for hospital outpatient clinic visits at off-campus, provider-based departments (PBD) and expanding last year’s payment reductions for drugs purchased under the 340B discount pricing program by nonexcepted PBDs.
CMS would use the proposed modifiers to implement a 15% payment reduction starting in 2022 for services provided in whole or in part by physical therapy assistants (PTA) and occupational therapy assistants (OTA).
CMS recently released new documentation guidance on medical review of E/M services performed by medical students. A medical student may document E/M services if the physician performs or re-performs the exam and then verifies the student’s documentation.
Many HIM directors find that managing the coding team requires a different type of focus than other functions within the department. This may be true because coding professionals have advanced education, prefer a quiet work environment, and require less direction.
