If you aren’t yet confused by the site-neutral payment policy changes prompted by CMS apparently ignoring both Congressional intent and the American Hospital Association (AHA) and other impacted hospitals filing suit, you are likely to become so now.
Findings from a December Office of Inspector General (OIG) report show that CMS based an estimated $2.7 billion in risk-adjusted payments on chart review diagnoses that Medicare Advantage organizations (MAO) didn’t link to specific services. Their findings highlight concerns about the validity of payment data submitted to CMS.
Coding productivity held steady for 2019 but the impact of misalignment between coding and CDI and unanswered physician queries suggest there's room for improvement. HIM Briefings' 2019 coding productivity survey dug into productivity benchmarks, coding accuracy benchmarks, and the impact of workflows and department structure.
The 2020 update to the CPT Manual includes extensive updates to cardiovascular codes, including new codes for pericardiocentesis and pericardial drainage, aortic grafting, and endovascular repair procedures.
In an effort to increase the medically appropriate use of transitional care management (TCM) services, CMS increased payment and removed billing restrictions for TCM services, as outlined in the 2020 Medicare Physician Fee Schedule (MPFS) final rule.
CMS recently published Transmittal 332 to inform Medicare administrative contractors and providers of new billing considerations, effective January 1, 2020, for medication-assisted treatments provided by opioid treatment programs.
Northwest Medical Center in Arizona received $201,624 from Medicare for incorrectly billed inpatient and outpatient services based on a sample of claims, according to a report released by the Office of Inspector General (OIG) on December 3. The OIG estimates that, based on the sample, the hospital may have received at least $1.2 million in overpayments during the audit period of January 1, 2016 through December 31, 2017.
Carolinas Hospital in Florence, South Carolina, received $431,757 in Medicare overpayments for incorrectly billed inpatient and outpatient services, according to an Office of Inspector General (OIG) audit report released November 26. Based on the sample, the OIG estimates the hospital may have received at least $3.4 million in overpayments.
In the 2020 Medicare Physician Fee Schedule (MPFS) final rule, CMS put a stamp of approval on its previous proposals to overhaul how medical practices will report office and outpatient E/M services in 2021.
The Centers for Disease Control and Prevention (CDC) updated its clinical guidance for diagnosing and treating electronic cigarette- or vaping-associated lung injuries (EVALI) in light of the approaching 2019-2020 flu season.
