Many hospitals find that their Patient Safety Indicator (PSI) ratios remain high despite doing a spectacular job of addressing these events and exclusions. That may be because they fail to realize that the Agency for Healthcare Research and Quality has a risk-adjustment methodology that predicts each of these PSIs and is dependent upon the documentation and coding of PSI-sensitive risk factors.
Preventive care is an essential component of rural health clinic services, but Medicare's coverage and billing rules for these services—including annual exams and vaccines—can be complicated to navigate.
In today’s uncertain regulatory environment, establishing an internal audit process is more important than ever to ensure proper billing and reimbursement. Follow these eight steps to establish an efficient internal audit and compliance program.
Cardiac device credits came under scrutiny in an Office of Inspector General report that found all 210 hospitals audited failed to adjust claims to reflect certain cardiac device manufacturer credits, leading to $4.4 million in overpayments from CMS.
In the 2018 OPPS final rule, CMS finalized a change to the current clinical laboratory date of service policies for outpatient molecular pathology tests and advanced diagnostic laboratory tests.
Changes to HCPCS and CPT® codes, drug and biological payments, and a new separately payable procedure code are coming in April. The transmittal announcing the updates also includes clarification on the application of the modifier –FY payment reduction.
One of the most memorable sessions at the AMA CPT Symposium in November 2017 involved an impromptu open mic feedback session facilitated by CMS’ Marge Watchorn, deputy director of the Division of Practitioner Services. The focus of this session was the applicability of the current CMS documentation guidelines for E/M services.
