July 19, 2016
News & Insights

Can a hospital that is not a critical access hospital bill professional charges on UB-04 claims, Type of Bill 013X?

July 8, 2016
News & Insights

CMS released the 2017 Medicare Physician Fee Schedule proposed rule yesterday, with policies that look to expand an Innovation Center program, revise payment for care management services, and collect data regarding global period payments. 

July 8, 2016
News & Insights

CMS proposes aligning its conditional packaging modifiers and deleting a much-maligned modifier for separately payable laboratory tests in the 2017 OPPS proposed rule, released July 6. 

July 12, 2016
News & Insights

Is diagnosis no longer a criteria for the observation APC payment?

July 7, 2016
News & Insights

CMS is looking to implement the Section 603 provisions of the Bipartisan Budget Act of 2015 regarding off-campus, provider-based departments by January 1, 2017, according to the 2017 OPPS proposed rule, released yesterday. 

June 24, 2016
News & Insights

CMS issued a final rule last week to revamp the way it pays for tests under the Clinical Laboratory Fee Schedule (CLFS), though the agency has pushed the start date back a year and worked to ease administrative burden based on public comments. 

June 8, 2016
News & Insights

In the July quarterly OPPS update, CMS mentions billing physical and occupational therapy and speech-language pathology services provided in support of or adjunctive to comprehensive APC services under revenue code 0940 rather than the NUBC-defined revenue codes. This article helps make sense of the situation.

June 10, 2016
News & Insights

If CMS’ late April release of a change request requiring reporting of the previously optional modifier -JW (drug amount discarded/not administered to any patient) by July 1 seemed too sudden, the good news is many other providers—and the agency—agreed.

June 1, 2016
Briefings on APCs

CMS' coding modifiers are not always used to report clinical components of a service. Sometimes they can be used in order to provide information about how a service relates to Medicare coverage policies.

June 1, 2016
Briefings on APCs

As healthcare providers increasingly accept financial risk associated with patient management due to the transition from fee-for-service to risk-/value-based reimbursement, the traditional model of healthcare reimbursement has been flipped upside down.

Pages