Social determinants of health are social factors, such as homelessness, illiteracy, a history of childhood trauma, and joblessness or underemployment, that can affect a person’s health. Coding for these factors is important because CMS officials now use some of them to adjust quality measures for patients who are dual-eligible for Medicare and Medicaid, and coding these factors may help shape future health policy.
In the April 2018 OPPS update transmittal, CMS announced new HCPCS code C9749 (repair of nasal vestibular lateral wall stenosis with implant[s]), effective April 1, 2018.
The recently released 2019 ICD-10-CM update adds some codes to allow additional diagnoses to be reported while adding others for greater specificity. The update includes more than 600 additions, deletions, and revisions.
Healthcare providers are often confused about what a commercial or managed care payer would want in order to approve the claim. Much of this confusion comes from the timing of requirements to ensure reimbursement.
The Hierarchical Condition Categories (HCC) risk-adjustment methodology is beginning to surface more frequently in both the acute and primary settings. Use these expert tips to help improve complete, compliant HCC capture.
When evaluating a code edit, it’s necessary to understand exactly when or where in the claim or billing process the edit arose. Look to coding guidance to help edit resolution efforts.
CMS plans to rebrand the Meaningful Use program as “Promoting Interoperability.” In a fact sheet, the agency said that the proposed changes outlined in the IPPS rule are meant to improve the use of EHRs and make it easier for providers to spend time with their patients.
CMS announced revised pricing for covered drugs and biologicals in the July 2018 update to the OPPS. Hospitals should thoroughly review all of the updates to ensure any required changes are in place by the stated effective dates.
Predicting CMS policies can be a foolhardy exercise, especially with a relatively new administration and frequent turnover at the highest levels of HHS over the last year. But it’s safe to say drug payment policy has been and will continue to be a focus of the current regime.
