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.
CMS introduced packaging guidance for total knee arthroplasty procedures paid under the OPPS and billed in conjunction with anesthesia administration as part of the July 2018 quarterly update to the integrated outpatient code editor.
CMS recently released MLN Matters SE18001 to provide healthcare practitioners with instructions and coding guidance for specimen validity when performed and billed in combination with drug testing. The article was issued to remind laboratories and other providers performing urine drug testing that specimen validity testing (SVT) is not separately billable.
CMS recently clarified the use of modifier -KX (requirements specified in the medical policy have been met) in response to an Office of Inspector General report that identified conflicting guidance that resulted in $4.6 million in improper payments.
