The April 2019 OPPS quarterly update reassigned specific skin substitute products from the low-cost group to the high-cost group, and clarified billing and reporting for chimeric antigen receptor T-cell (CAR-T) therapy procedures performed in the outpatient setting.
A recent study found that hospitals may see lower revenue and higher uncompensated care costs in states that implement Medicaid work requirements. States-specific Medicaid program designs may help to mitigate the potential impact, depending on how many beneficiaries lose coverage.
Coding for knee arthroscopies can be challenging, especially when procedures are performed in multiple compartments of the same knee. Read about anatomy and coding details required to accurately report these procedures.
The American Medical Association’s (AMA) CPT Editorial Panel approved significant changes to E/M reporting guidelines, including the deletion of a visit code, creation of new criteria for the selection of a visit level, and overhaul of the medical decision-making (MDM) documentation guidelines at a meeting held in February, to align with recent E/M changes finalized by CMS.
A proposed rule from HHS’ Office of the National Coordinator for Health Information Technology (ONC) could mandate the publication of prices negotiated between payer and provider organizations as well as detailed information about Medicare reimbursement, DRG prices, and bundled prices.
Many outpatient CDI professionals stepped into their roles blind—not knowing where to begin or how to tell if they were successful. However, as programs mature, they need to be able to track their progress for a number of reasons, including focusing physician education and justifying continued funding from organizational leadership.
CMS recently pushed back the start date for Medicare Administrative Contractors (MAC) to expand coverage terms for patients in need of an implantable cardiac defibrillator (ICD) by one month. The agency released Transmittal 213 on February 15, announcing a delayed implementation date of March 26.
Accountable care organizations that have switched tracks to take on downside risk tend to be larger, located in urban areas, and more successful on financial metrics, according to a recent report. However, the report did not find any significant relationship between switching to downside risk tracks and improvement on quality or public health metrics.
Accurate and detailed medical documentation is critical for patient safety and to ensure payment for services rendered. Use these tips to keep clinical trials documentation compliant.
In the 2018 OPPS final rule, CMS removed total knee arthroplasty (TKA) from the inpatient-only (IPO) list effective January 1, 2018. Although some guidance was provided at the time, providers and physicians alike were left confused with a significant number of questions regarding documentation and inpatient status
