CMS is moving forward with multiple policies—effectively based on reducing reimbursement to hospitals—that have been deemed unlawful in court, according to the 2020 OPPS final rule, released Friday, November 1. However, the agency pushed its controversial price transparency proposals to a separate, yet-to-be released final rule.
As Medicare Advantage makes strides to becoming the new norm, organizations need to establish new processes, educate staff, and advocate for patients. Learn how your organization can keep pace with change before it’s too late to catch up.
Almost a year after CMS required hospitals to post their chargemaster online, some hospitals are going beyond the basic requirements while others lag behind, according to a recent analysis.
Oceanside Medical Group, a clinic providing mental health services in Santa Monica, California, is disputing an Office of Inspector General (OIG) report that estimated the group received $2.6 million in overpayments for psychotherapy services by failing to comply with Medicare billing and documentation requirements.
The 2020 IPPS final rule made major changes to the hospital wage index and new technology payments. Brush up on the details to ensure your organization is ready.
Facility evaluation and management (E/M) coding is based on the facility resources utilized to provide medical care. Because CMS has not created national E/M guidelines for emergency department (ED) services, providers must create their own criteria for each visit level. Review your organization’s ED E/M leveling policies to ensure compliance.
OCR in 2013, through the Health Information Technology for Economic and Clinical Health (HITECH) Ac,t issued a final rule identifying provisions of the HIPAA rules that apply directly to business associates (BA) and those provisions for which BAs are directly liable.
CMS is proposing several revisions to its clinical diagnostic laboratory date of service (DOS) policy in the FY 2020 OPPS proposed rule, including requiring ordering physicians to determine whether tests are intended to guide treatment during a current or future outpatient encounter.
Starting January 1, 2020, the education and operations testing period will kick off, and organizations will be required to report appropriate use criteria (AUC) consultation information. Learn what you can do now to help your organization prepare to report AUCs in 2020 and beyond.
