Understand their purpose and triggers to help hospitals improve performance ratings tied to payment. In this climate of quality care, the ability to measure and track clinical performance and outcomes within a facility is essential. The Agency for Healthcare Research and Quality (AHRQ) developed Quality Indicators for that purpose. There are four categories of AHRQ ...
In Billing
May 31st, 2019
The Durable Medical Equipment Medicare Administrative Contractors (DME MAC) are changing the requirement that medical coders to use the right (RT) and left (LT) modifiers for certain HCPCS codes, and that the modifiers be used when billing two of the same item or accessory on the same date of service and the items are being ...
In CMS
Jan 21st, 2019
Intermountain Healthcare wants the Supreme Court to weigh in on if the False Claims Act’s (FCA) provisions for whistleblowers violates the Constitution. This could affect compliance efforts across healthcare. Medical Judgment No FCA Sanctuary The issue arose last summer when the US Court of Appeals for the Tenth Circuit ruled that medical judgment can’t be ...
In Billing
Jan 16th, 2019
The Centers for Medicare & Medicaid Services (CMS) has released 15 corrections to the 2019 HCPCS Level II code set, all retroactive. Of the 15 codes, five are added, one discontinued, and seven reflect changes to payment or coverage status. One modifier introduced in 2011 CMS ruefully admits was “removed in error” and is reinstated. ...
In CMS
Dec 18th, 2018
Even though U.S. Northern District of Texas Court Judge Reed O’Connor struck down the Affordable Care Act (ACA or Obamacare), there are three good reasons to neither panic nor change your medical practice’s policies or your medical coding. Judge O’Connor ruled the law as unconstitutional, agreeing with 20 state attorneys general that the Individual Mandate ...