CMS released Transmittal 4188 on December 28, adding instructions to Chapter 23 of the Medicare Claims Processing Manual for the accurate interpretation of claim edits and assignment of modifiers -59 (distinct procedural service) and -91 (repeat clinical diagnostic laboratory test) on Medicare Part B claims.
Despite facing potential lawsuits and political opposition, CMS finalized some of its most controversial proposals in the 2019 OPPS final rule by implementing several site-neutral payment policies and 340B drug payment reductions.
Findings from a retrospective analysis of inpatient data recently published in Critical Care Medicine show that average hospital costs and mortality rates are significantly higher for patients diagnosed with sepsis after hospital admission when compared with patients diagnosed prior to admission.
A proposed rule that would expand the use of prior authorization and step therapy for Part D and Medicare Advantage beneficiaries has earned criticism from patient advocacy groups and praise from pharmacy groups.
Along with E/M changes for 2019 and beyond, the 2019 Medicare Physician Fee Schedule final rule contains a plethora of regulations impacting reimbursement, including new modifiers for therapists.
Q: If a patient participating in a clinical trial is allergic to one of the drugs used in the trial, how do we report the drug that is used as a substitute?
Medicare’s new method of calculating payment rates for laboratory tests, intended to reduce Medicare spending by $360 million in the first year, could cost the agency billions in overpayments, according to a recent report from the U.S. Government Accountability Office.
Hospital price growth is falling, according to a November price brief from Altarum. In October, hospital price growth rose by 1.3% compared to October 2017, the lowest annual price growth rate since September 2017.
