In Audit
Aug 21st, 2018
An OIG review shows Medicare overpaid outpatient hospitals as much as $25.8 million for complex simulations billed during audit period. Between 2013 and 2015, Medicare paid 1,193 hospitals $109,197,933 in bundled payments for intensity modulated radiation therapy (IMRT) — about $25,754,171 more than they should have, according to the Office of Inspector General (OIG). The ...
In Billing
Jul 26th, 2018
The long-awaited 2019 Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) proposed rule, released July 25, sets the wheels in motion for significant reforms in the way Medicare will pay providers in hospital outpatient settings. The Centers for Medicare & Medicaid Services (CMS) is moving toward site-neutral payments for clinic visits, which will save ...
In Coding
Jun 6th, 2018
Part 1: Educated coders and providers are crucial to claim success. Delivering quality care, while ensuring effective clinical documentation and compliant medical coding, is an ongoing challenge in a fast-paced emergency department (ED). Over the next two months, we’ll review best practices to optimize coding compliance and reimbursement of ED claims. In part 1 of ...
In Billing
May 3rd, 2018
Advocates are seeking to convince the Centers for Medicare & Medicaid Services (CMS) to pay for outpatient care of patients receiving 31241 Nasal/sinus endoscopy, surgical; with ligation of sphenopalatine artery. The new code for 2018 was assigned a fee status of “inpatient only.” This is inconsistent with the current state of practice. Even though the complexity of ...
In Audit
Mar 23rd, 2018
A medical review conducted by the Office of Inspector General (OIG) found 61 percent of claims (out of 300 sampled) for outpatient physical therapy services did not comply with Medicare medical necessity, coding, or documentation requirements. Although the Centers for Medicare & Medicaid Services (CMS) generally disagreed with OIG’s findings, a review of the requirements ...