One of the most vexing challenges that CDI specialists have is how to engage physicians to completely and precisely document their patients’ conditions and treatments in the language required by ICD-10-CM, which is essential to risk adjustment.
The American Hospital Association (AHA) and the Association of American Medical Colleges (AAMC) recently filed a lawsuit against the Department of Health and Human Services (HHS) for continuing to reduce payments for hospital outpatient services provided in grandfathered, off-campus provider-based departments (PBD) in the fiscal year 2020 OPPS final rule.
HHS’ Health Resources and Services Administration (HRSA) should step up oversight of hospitals participating in the 340B drug discount program, the U.S. Government Accountability Office (GAO) recommended in a recent report.
If you aren’t yet confused by the site-neutral payment policy changes prompted by CMS apparently ignoring both Congressional intent and the American Hospital Association (AHA) and other impacted hospitals filing suit, you are likely to become so now.
Findings from a December Office of Inspector General (OIG) report show that CMS based an estimated $2.7 billion in risk-adjusted payments on chart review diagnoses that Medicare Advantage organizations (MAO) didn’t link to specific services. Their findings highlight concerns about the validity of payment data submitted to CMS.
Q: What is the process for submitting a claim for an inpatient hospitalization when our utilization review committee determined after discharge that the inpatient admission was not medically necessary?
The 2020 update to the CPT Manual includes extensive updates to cardiovascular codes, including new codes for pericardiocentesis and pericardial drainage, aortic grafting, and endovascular repair procedures.
In an effort to increase the medically appropriate use of transitional care management (TCM) services, CMS increased payment and removed billing restrictions for TCM services, as outlined in the 2020 Medicare Physician Fee Schedule (MPFS) final rule.
The government is starting a trial program in the District of Columbia that aims to improve treatment for Medicaid beneficiaries struggling with serious mental illness or substance use disorders.
