Healthcare organizations and providers are experiencing a shift in outpatient reimbursement: from fee-for-service to Alternative Payment Models and value-based reimbursement based on quality outcomes.
Adriane Martin, DO, FACOS, CCDS writes about the signs and symptoms of peripheral arterial disease (PAD) and ICD-10-PCS guidelines for reporting the condition.
Reduced and discontinued service modifiers indicate to the payer when service is either less than the HCPCS code indicates (reduced) or the procedure was stopped before completion (discontinued).
Findings from an Office of Inspector General (OIG) audit show that Essence Healthcare Inc. submitted claims with high-risk ICD-10-CM codes for acute stroke and major depressive disorder that did not comply with federal requirements, resulting in at least $158,000 in overpayments to Medicare Advantage.
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.
