U.S. District Judge Rudolph Contreras last week reaffirmed that the U.S. Department of Health and Human Services (HHS) exceeded its authority when it made 2018 payment cuts to outpatient hospitals for certain drugs purchased through the 340B drug pricing program, and extended the ruling to 2019 payment cuts.
A recent MLN Matters article clarifies language in the Medicare Claims Processing Manual to match current documentation policy for evaluation and management (E/M) services billed by teaching physicians.
Reduced and discontinued service modifiers indicate to the payer when service is either less than the HCPCS code indicates (reduced) or the procedure was stopped before completion (discontinued).
Findings from an Office of Inspector General (OIG) audit show that Essence Healthcare Inc. submitted claims with high-risk ICD-10-CM codes for acute stroke and major depressive disorder that did not comply with federal requirements, resulting in at least $158,000 in overpayments to Medicare Advantage.
Although the Comprehensive Primary Care Plus (CPC+) model saw high rates of provider participation and support from CMS , it had minimal impact on care outcomes or cost in 2017, according to the first annual report on CPC+.
The Office of Inspector General is stepping up audits of inpatient rehabilitation facility (IRF) claims. Use these expert tips to ensure your facility is coding and billing correctly for these services.
Q: Does CMS' molecular pathology/advanced diagnostic laboratory test date of service policy apply to Traditional Medicare only or does it also apply to Medicare Advantage?
Hospital coders must develop and adhere to internal E/M coding guidelines and CPT guidance to accurately report visits to the ED. In addition, because ED coding encompasses professional and facility billing, they may need to scour provider documentation to determine the correct E/M service level for both bill types.
