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.
CMS’ fiscal year (FY) 2020 Inpatient Prospective Payment System (IPPS) proposed rule, released April 23, includes a proposed increase to hospital payment rates, annual ICD-10-CM/PCS code update proposals, and significant changes to complication or comorbidity (CC)/major complication or comorbidity (MCC) and Medicare-Severity Diagnosis-Related Group (MS-DRG) designations.
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.
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.
The American Medical Association (AMA) and UnitedHealthcare announced a collaboration to better address social determinants of health (SDoH) by standardizing how this data is collected and processed through the creation of new ICD-10 codes related to SDoH.
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.
