The Government Accountability Office (GAO) has urged CMS to renew prior authorization programs slated to expire. The GAO made its case for continuing the programs in a report released in April, arguing that the programs reduced spending by nearly $2 billion since 2012.
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.
The brain is the most complex component of the central nervous system, consisting of approximately 100 billion neurons that communicate via an exponential number of synapses. Coding for the brain can seem almost as complex. Brush up on ICD-10-CM/PCS coding for the brain.
Correct, complete documentation is the foundation of a sound medical record and compliant reimbursement, but getting that foundation in place can be challenging. Clinicians are juggling critical tasks in a high-stress situation, and administrative burden of electronic documentation and the disconnect that results from spending more time looking at a screen than a patient are often cited as the primary factors in physician burnout. Enter the medical scribe.
A coding audit may be conducted by internal staff or external entities, typically representing the insurers paying for the care. When planning to implement a coding auditing program, the type of reviews, focus areas, and review frequency must all be taken into consideration.
Medicare billing edits such as National Correct Coding Initiative (NCCI) edits and Medically Unlikely Edits (MUE) must be resolved at their root cause so that they do not continue to occur on claim
CMS released the fiscal year (FY) 2019 IPPS proposed rule on Tuesday, April 24, with an overhaul of the Meaningful Use program and significant reductions to reporting requirements for quality initiatives, along with updates to payment rates.
A CMS fact sheet reminds providers to brush up on their MIPS knowledge in regard to the quality performance category. This performance category is worth 50% of providers’ final MIPS score for 2018, and providers who demonstrate improvement from their performance in the category in 2017 could earn bonus points this year.
Organizations are generally keeping up due diligence when it comes to HIPAA compliance training and essential auditing, despite an increasingly challenging array of threats directed at them. However, confusion still holds sway on risk analysis and more robust audit functions.
