Providers need to be careful when reporting multiple services with status indicator J1 on the same claim, as NCCI logic could result in no payment for any of the reported comprehensive APC (C-APC) services.
Providers know the drill for addressing and operationalizing CMS' annual IPPS and OPPS updates, along with the usual ICD-9-CM and CPT® coding changes. The industry has become used to CMS' timetable for releasing inpatient and outpatient proposed and final rules and knows that it has to be ready to go live with coding, billing, and operational changes October 1 and January 1, respectively.
After several delays, ICD-10 implementation is finally upon us. The healthcare industry has spent years planning, training, and testing?and now the moment we have all been waiting for has arrived. But don't breathe a sigh of relief just yet.
After years of delays, industry and legislative pushback, and millions spent on technology upgrades and education, ICD-10 is finally here. Even though the fundamental process of coding and billing claims has not changed, providers will still need to pay close attention to their processes to keep the revenue cycle going and reduce denials.
Regulations adopted in October 2013 allow hospitals to bill Part B for inpatient cases that are internally reviewed and "self-denied" within one year of the date of service. But utilization review staff are unsure when to use the old condition code 44 process and when to opt for the new process using condition code W2. Operationalizing these rules can prove to be challenging, causing recoding, rebilling, and expensive slowdowns in the revenue cycle.
As providers work to implement policies and regulations introduced by CMS in the 2016 OPPS final rule, they should take some time before January 1 to make sure they’re ready to potentially report modifier –CT (computed tomography services furnished using equipment that does not meet each of the attributes of the National Electrical Manufacturers Association [NEMA] XR-29-2013 standard).
This week’s note is regarding the packaging of laboratory tests. It is written by Valerie A. Rinkle, MPA, regulatory specialist for HCPro. Ms. Rinkle is new to the HCPro team, and a nationally recognized Medicare expert. For more information about this exciting addition to the HCPro team, click here.
This week’s updates include an update to the list of compendia for the determination of a “Medically-Accepted Indication” of drugs and biologicals used off-label in an anti-cancer chemotherapeutic regimen; a payment reduction for Computed Tomography (CT) diagnostic imaging services; and more!
This week’s updates include updates to clarify inpatient rehabilitation facility (IRF) claims processing; a revised hospital guidance for pharmaceutical services and expanded guidance related to compounding of medications; and more!
