In CMS
Jan 12th, 2018
The Centers for Medicare & Medicaid Services (CMS) announced on Jan. 9 the launch of their Innovation Center’s Bundled Payments for Care Improvement Advanced (BPCI Advanced) payment model. It’s voluntary and can earn providers payment if all costs for a patient’s episode of care are “under a spending target that factors in quality.” This differs ...
In Billing
Dec 13th, 2017
In case you were unaware of proper billing of services for Medicare patients in a covered Part A inpatient stay, here is a refresher. Medicare will not pay acute-care hospitals for outpatient services provided to patients in a covered Part A inpatient stay at another facility. This includes Medicare patients who are inpatients of long-term ...
Dec 5th, 2017
Medicare claims payment hinges on knowing the differences between settings. Inpatient and outpatient coding, although similar in theory, are very different. Services performed in either setting are reported using different code sets and guidelines. Services are paid differently, as well. For example, “original” Medicare inpatient claims are paid under Part A and outpatient claims are ...
In Audit
Nov 22nd, 2017
The Office of Inspector General (OIG) is recommending Rush University Medical Center, Chicago, Ill., refund $10.2 million in Medicare overpayments based on an audit sample of 120 inpatient and outpatient claims. Rush allegedly did not fully comply with Medicare billing requirements for 57 of the claims, resulting in overpayments of $814,150 for the audit period (2014-2015). The OIG ...
In Coding
Jun 26th, 2017
If a patient is placed under observation status and is discharged on the same date of service, proper coding will depend on whether the observation status lasted fewer than, or more than, eight hours. — For observation status lasting fewer than eight hours, report initial observation care (99218-99220 Initial observation care, per day, for the ...