The Patient-Driven Payment Model (PDPM) has so many nuances that can impact reimbursement that it is near impossible for SNFs to consider and capitalize on them all. Check your processes and procedures to ensure you’re taking advantage of or protecting against the following aspects of PDPM.
An August report from the Office of Inspector General (OIG) found that Oceanside Medical Group, a clinic providing mental health services in Santa Monica, California, received $2.6 million in overpayments for psychotherapy services by failing to comply with Medicare billing and documentation requirements.
Along with its annual updates to the inpatient-only list, the 2020 Outpatient Prospective Payment System (OPPS) final rule finalized a proposal that will give hospitals a grace period to adjust internal policies for procedures recently removed from the inpatient-only list.
As of October 1, approximately 1,080 cases of respiratory illnesses and 18 deaths brought on by vaping have been reported in the U.S., according to the U.S. Centers for Disease Control and Prevention (CDC). Despite continued research into these cases by the CDC and the U.S. Food and Drug Administration (FDA), the specific cause of these illnesses remains unknown.
CMS is moving forward with multiple policies—effectively based on reducing reimbursement to hospitals—that have been deemed unlawful in court, according to the 2020 OPPS final rule, released Friday, November 1. However, the agency pushed its controversial price transparency proposals to a separate, yet-to-be released final rule.
Q: How should we handle denied claims when the payer refuses payment under the billed status? Do we need to document that the status was changed only because the payer did not agree to any other options?
Chimeric antigen receptor T-cell (CAR-T) therapy provided to Medicare Advantage (MA) beneficiaries will be paid for by traditional Medicare for calendar years 2019 and 2020.
Kalispell Regional Healthcare (KRH) in Montana recently announced an email data breach that may have exposed the protected heath information of nearly 130,000 of its patients.
