The Office of Inspector General (OIG) will review Medicare’s diagnosis-related group (DRG) window policy to determine whether the program could save money by expanding the policy to include more days, according to an update to the OIG Work Plan.
CMS could have saved its beneficiaries an additional $2.9 million in 2017 had it implemented a more expansive price substitution policy for Part B drugs, according to an Office of Inspector General (OIG) report.
Findings from a Comprehensive Error Rate Testing (CERT) study show that insufficient documentation caused most improper payments for chiropractic services billed to Medicare in 2018, according to the July 2019 Medicare Quarterly Compliance Newsletter.
Behavioral health is a highly specialized area of coding that many coders and billers are unfamiliar with. There are hundreds of ICD-10-CM codes for mental disorders with unique characters to specify symptoms and complications.
Facility evaluation and management (E/M) coding is based on the facility resources utilized to provide medical care. Because CMS has not created national E/M guidelines for emergency department (ED) services, providers must create their own criteria for each visit level. Review your organization’s ED E/M leveling policies to ensure compliance.
CMS’ inpatient-only rule seems simple enough on the surface—certain specified procedures, all noted in the OPPS inpatient-only list, must be performed on an inpatient basis regardless of the patient’s expected length of stay. But as with anything in healthcare, implementing this rule is hardly simple, and many organizations continue to misapply it and lose revenue as a result. Get expert answers to common inpatient-only compliance stumbling blocks.
