Root cause analysis of edits and an understanding of the relationship between the chargemaster and HIM/coding must be supported by overarching principles and best practices for edit management. Processes should be built around the timing of edits, applying edits across payers, and denial management.
On October 4, CMS issued a notice in the Federal Register containing numerous corrections to the 2018 IPPS final rule, including significant recalculations of MS-DRG relative weights and all budget neutrality factors.
The new ICD-10-CM codes for FY 2018, effective October 1, represent significant changes in our documentation and coding practices. Let’s discuss some of these new codes and their potential impact upon your diagnostic decision-making and documentation.
In a rare bipartisan effort from Congress, 228 members of the House of Representatives urged CMS to abandon a proposal from the 2018 OPPS proposed rule which would drastically cut payments for hospitals participating in the 340B drug discount program.
Providers in some states may soon discover a big hurdle to clear when seeking to report a set of apheresis services after one MAC tightened up physician supervision requirements.
The Office of Inspector General found CMS improperly awarded an estimated $4.6 million in reimbursement for immunosuppressive drugs billed with modifier -KX (requirements specified in the medical policy have been met). The OIG also said CMS should revise guidance on modifier -KX because current guidance is confusing and contradictory.
In the 2018 OPPS proposed rule, CMS proposed a change to the current clinical laboratory date-of-service policies for molecular pathology tests and for Advanced Diagnostic Laboratory Tests.
In a series of press releases, CMS announced certain public health emergency policies are in effect for the parts of Texas, Louisiana, and Florida hit by Hurricanes Harvey and Irma.
The new ICD-10-CM codes for FY 2018, effective October 1, 2017, represent significant changes in some of our documentation and coding practices. Review the changes to the FY 2018 ICD-10-CM Official Guidelines for Coding and Reporting (the Guidelines), which must be embraced if our documentation, coding, and billing is to withstand compliance scrutiny from outside auditors and accountability agents.
