This week’s updates include the temporary pause of QIO short stay reviews; review of CMS' Pioneer Accountable Care Organization Payment Model first performance year administration; and more!
Providers, clinic staff, billing entities, and patients continue to struggle with new reporting requirements for rural health clinics six weeks since the implementation. Read for an expert's analysis of the most recent information CMS has distributed on the requirements.
There are new enforcement editing requirements regarding the coverage and billing of Partial Hospitalization Program services, likely due to significant problems with these claims and coding highlighted in the 2016 proposed and final OPPS rules.
This week’s updates include a transmittal regarding completing and processing Form CMS-1500 Data Set; a transmittal from Provider Reimbursement Manual, Part 1–Chapter 31 on Organ Acquisition Payment Policy; and more!
This week Medicare Insider is featuring an excerpt from Patient Status Training Toolkit for Utilization Review by Kimberly Anderwood Hoy Baker, JD, regulatory specialist for HCPro.
This week’s updates include reporting principal and interest amounts when refunding previously recouped money on the Remittance Advice; Changes to the laboratory NCD edit software for July 2016; and more!
The new modifier -PO (services, procedures, and/or surgeries furnished at off-campus provider-based outpatient departments [PBD]) and the alternative payment provisions under the Bipartisan Budget Act Section 603 are both related to off-campus PBDs but define "off-campus PBD" slightly differently.
The Social Security Act allows CAHs and other small rural hospitals to enter into “swing bed” agreements with CMS. Under these arrangements, in addition to providing acute inpatient services, such hospitals are permitted to provide extended care services that would normally be furnished in a skilled nursing facility (SNF). When provided under a swing bed arrangement, SNF extended care services are referred to as “swing bed” services. In a swing bed hospital, an inpatient bed may actually swing from one level of care to another (e.g., acute to swing or swing to acute), depending upon a particular patient’s need.
