Resolving claims returned with National Correct Coding Initiative edits or Medically Unlikely Edits can be a time-consuming process. Organizations need processes to promote best practices and keep appeals on track, as well as coding and billing policies that address common front-end problems that lead to these edits.
CMS released the fiscal year (FY) 2018 IPPS final rule August 2, updating Medicare payment and polices for patients discharged from hospitals from October 1, 2017, to September 30, 2018.
CMS updated its website for the Quality Payment Program recently with new information clarifying which clinicians will have “special status” and may be exempt from submitting data this year.
The new ICD-10-CM codes for FY 2018, effective October 1, represent significant changes in our documentation and coding practices. In follow-up to last month’s column, let’s discuss additional new codes and their potential impact upon your diagnostic decision-making and documentation.
When Spencer Johnson wrote the iconic book, Who Moved My Cheese? An A-Mazing Way to Deal With Change in Your Work and in Your Life, he probably didn’t have the homecare industry in mind. But with the speed of reimbursement and regulatory issues surrounding us today, he certainly could have.
Whether it is the CPT Manual or Chapter 12 of the Medicare Claims Processing Manual, the definition of a “new patient” is the same for physicians and nonphysician practitioners billing. But that doesn't mean coding and billing for E/M services is clear cut.
CMS proposed a handful of changes to the inpatient-only list in the 2018 OPPS proposed rule, including the removal of total knee replacement procedures from the list despite receiving mixed feedback on that idea last year.
As CMS and third-party payers have looked for ways to treat patients in the outpatient setting and reduce inpatient volumes, CMS has used the 2-midnight rule, in addition to other methods, to treat patients as outpatients or in observation whenever possible.
The display copy of the Quality Payment Program proposed rule was released in June, and you can think of this rule as a companion to the Medicare Physician Fee Schedule that typically comes out with the OPPS rule. That means both rules need to be read, understood, and, ideally, commented on by providers.
Carolinas Healthcare System agreed to pay $6.5 million to settle allegations of a years-long practice of upcoding urine drug tests, the Office of Inspector General announced June 30.
