Billing and reimbursement

Our experts answer questions about Composite APCs, modifier –CT, and more.

This month's column is all about data--the importance of providers reporting accurate and complete data, as well as CMS having complete, accurate, and consistent data to compute future payment rates.

The CPT Manual divides drug administration services into three different categories:

• Hydration (CPT codes 96360-96361)
• Therapeutic, prophylactic, and diagnostic injections and infusions (96365-96379)
• Chemotherapy and other highly complex drug or highly complex biologic agent administration (96401-96549)

The 2016 CPT® code update may have been relatively small compared to previous years, but the urinary and genital system sections did receive numerous changes to align them with other sections of the code book.

by Kimberly Anderwood Hoy Baker, JD

This week’s note is about changes in the April quarterly OPPS update. 

Despite industry pushback and several delays, ICD-10 implementation has, against all odds, gone relatively smoothly for the vast majority of providers, leading CMS to tout its success in a recent blog post from Andy Slavitt, CMS’ acting administrator. 

Q: Can you self-deny a claim after you've already received Part A payment for it?

Q: How does TOB 131 bump against TOB 121 in regard to the 72-hour rule?

CMS won’t release guidance on the payment impact of Section 603 of the Bipartisan Budget Act of 2015 until the 2017 OPPS proposed rule, but the American Hospital Association (AHA) has weighed in with a letter to Congress urging the government to reject further site-neutral payment policies.