Proper use of suspense, or hold, periods can ensure claims are complete and accurate before they go out the door. But without careful monitoring and limits, these periods can create more problems than they solve. Take a look at the hows and whys of suspense periods to ensure your organization is using them appropriately.
Facility E/M coding reflects the volume and intensity of resources utilized by the facility during patient encounters. Joe Rivet, Esq., CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO, describes how facilities can create internal guidelines and point systems for determining E/M level section.
The fiscal year (FY) 2022 Inpatient Prospective Payment System (IPPS) proposed rule makes broad efforts to cushion the ongoing impact of the COVID-19 pandemic on hospital revenue and resources. The proposed rule, released April 27, also eliminates sweeping changes to MS-DRG rate-setting finalized in the 2021 IPPS final rule.
Q: What revenue code should be attached to HCPCS codes M0239 (intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring) and M0243 (intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring)? We set it up as revenue code 260 but are getting edits to change it to 771. What are your thoughts and suggestions?
CMS is reminding providers to ensure that Medicare claims for telehealth are correctly billed. The agency issued broadly expanded telehealth services as part of its response to the COVID-19 public health emergency.
The most impactful overhaul to the E/M coding and documentation guidelines in 25 years went live January 1. The updated guidelines eliminate medical history and physical examination as required elements for reporting E/M codes 99202-99215. E/M coding for outpatient visits is now based on documentation of medical decision-making (MDM) or time spent on the encounter.
The American Medical Association and dozens of specialty physician groups sent a letter to CMS on April 7 urging the agency to delay the implementation of new prior authorization requirements slated to go into effect this summer for certain outpatient services.
Q: We're looking for ways to bring our CDI and coding teams together to improve documenation and coding for appropriate Hierarchical Condition Categories (HCC) capture. Are there any recommended models and should other departments or individuals be working alongside them?
CMS should rescind denials recently issued to certain off-campus provider-based departments (PBD) that applied for the mid-build exception under the 21st Century Cures Act, the AHA said in a March 25 letter to CMS.
Sunrise Hospital & Medical Center in Winchester, Nevada, submitted Medicare claims for rehabilitative services that did not comply with Medicare billing requirements, resulting in an estimated $23.6 million in overpayments submitted over a two-year period, according to an April Office of Inspector General (OIG) report.
