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.
Providers working in outpatient hospitals, comprehensive outpatient rehabilitation facilities, and skilled nursing facilities frequently misreported and incorrectly billed for untimed therapy services, according to findings in the April Medicare Quarterly Provider Compliance Newsletter.
Telehealth services are likely to promote health, wellness, and disease management, providing an avenue to offer efficient, high-quality care while supporting value-based care in a cost-effective manner. Although the benefit of telehealth is obvious and its value is continually highlighted by CMS, it appears the services are underutilized.
Provider participation in the BPCI Advanced program fell by 16% between October 1, 2018, and March 1, 2019, at the initiation of the risk-bearing phase of the voluntary payment program. Overall participation includes nearly 1,300 providers still participating, according to CMS.
Representatives from CMS and the Office of Inspector General (OIG) discussed hot topics and focus areas at HCCA's 2019 Compliance Institute in Boston, including developing interactive documentation checklists, potential changes to Stark Law this year, and methods to address the high rate of coding and documentation errors on inpatient rehabilitiation facility (IRF) claims.
Providers will find significant leeway in how they can approach and report advance care planning services for physicians given CMS’ open-ended coding requirements, which should push the already strong growth of the codes to new heights.
CMS finalized changes to NCCI Medically Unlikely Edits (MUE) and procedure-to-procedure (PTP) edits in its quarterly update to NCCI edit files, effective April 1.
