CMS held a listening session March 21 to gather input from stakeholders on potential updates to the E/M documentation guidelines. The current guidelines are considered outdated in light of medical advances and the advent of the electronic health record.
CMS reminded organizations to pay attention to billing and coding for specimen validity testing done in conjunction with drug testing. The agency reviewed recent code changes and billing guidelines for these lab tests in Special Edition MLN Matters 18001 released on March 29. CMS emphasized that providers that perform validity testing on urine specimens cannot separately bill the validity testing.
The shift from fee-for-service to value-based programs for outpatient payment systems has increased the need for outpatient CDI staff to review documentation for pertinent clinical factors.
Amidst the hospital-of-the-future buzz at HIMSS18 was keen interest in resources aimed at helping providers navigate the present-day transition to value-based care. Many healthcare executive and clinician attendees were eager to identify ways healthcare technology can help their organizations transition from fee-for-service to pay-for-performance reimbursement models.
Medicare Advantage plan payment rates will increase by an average of 3.4% in 2019 due to higher projected per-capita cost growth for Medicare fee-for-service. The final pay bump is significantly higher than the 1.84% increase proposed in the 2019 advance notice.
With the expansion of telehealth services, providers for both the originating site and distant site can also count on the expansion of Medicare contractor audits.
A patient came to our endoscopy suite for a bronchoscopy due to an abnormal chest X-ray. The physician documented that a transbronchial lung biopsy was obtained from the right upper lobe and the right lower lobe. What would be the correct CPT® codes to report?
CMS instructed Medicare Administrative Contractors (MAC) to review previously denied 2018 outpatient therapy claims reported with modifier -KX. However, because MACs might not automatically review all denied therapy claims, providers will need to initiate the process.
