CMS made certain concessions from its proposed site-neutral payment policies required by Section 603 of the Bipartisan Budget Act, but it is still moving forward with implementation January 1, 2017, according to the 2017 OPPS final rule.
This week’s Medicare updates include the OIG’s Semiannual Report to Congress, an announcement that the Hospital Appeals Settlement Process is now open, a HCPCS Code Update for Preventive Services, and more!
Most of us are familiar with ICD-10-CM through picking codes from a list in our EHRs or perusing a printed code book. Allow me to suggest that unless we understand the coding rules in the ICD-10-CM Official Guidelines, we may mistakenly pick the wrong code, leading to a potential false claim.
The 30-day all cause acute myocardial infarction (AMI) mortality outcome measure has been linked to hospital payments since the inception of the Hospital Value-Based Purchasing Program (HVBP) in fiscal year 2013. In February 2016, CMS announced that 70% of commercial payers have agreed to use this measure as one of the cardiology outcomes linked to payment.
Today’s HIM professional needs to understand the various programs and the impact that coding and documentation may have on an organization’s performance. By 2018, 50% of Medicare payments will be tied to value-based alternative payment models.
Most healthcare systems already have a proven process in place to monitor revenue integrity and ensure correct reimbursement. Beyond the day-to-day revenue cycle staff involved in revenue integrity, more than 60% of hospital executives believe revenue integrity is essential to their organization’s financial stability and sustainability, according to a survey by Craneware, Inc.
Almost a year after the world of coding was transformed by the implementation of ICD-10-CM/PCS, CMS released the 2017 ICD-10-CM Official Guidelines for Coding and Reporting along with more than 5,000 diagnosis and procedure code changes. The new codes and guidelines went into effect October 1, but not without some controversy. Many of the changes were praised for the increased clarity and level of detail they allow providers to capture. Other changes, though, raised questions and eyebrows and left some wondering what the Cooperating Parties may have intended.
