When evaluating a code edit, it’s necessary to understand exactly when or where in the claim or billing process the edit arose. Look to coding guidance to help edit resolution efforts.
CMS announced revised pricing for covered drugs and biologicals in the July 2018 update to the OPPS. Hospitals should thoroughly review all of the updates to ensure any required changes are in place by the stated effective dates.
Predicting CMS policies can be a foolhardy exercise, especially with a relatively new administration and frequent turnover at the highest levels of HHS over the last year. But it’s safe to say drug payment policy has been and will continue to be a focus of the current regime.
The Government Accountability Office (GAO) has urged CMS to renew prior authorization programs slated to expire. The GAO made its case for continuing the programs in a report released in April, arguing that the programs reduced spending by nearly $2 billion since 2012.
CMS is looking to reduce reporting and documentation requirements for inpatient rehabilitation facilities (IRF) in the 2019 IRF payment system proposed rule, published in the Federal Register May 8. The proposed changes could come as a relief to IRFs that have seen a significant uptick in audits and denials.
CMS recently released MLN Matters SE18001 to provide healthcare practitioners with instructions and coding guidance for specimen validity when performed and billed in combination with drug testing. The article was issued to remind laboratories and other providers performing urine drug testing that specimen validity testing (SVT) is not separately billable.
