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 ...
In CMS
Feb 8th, 2018
In 2018, eligible clinicians will attest to Meaningful Use of certified electronic health record technology (CEHRT) through the Quality Payment Program. Medicare eligible hospitals, critical access hospitals (CAHs), and dual-eligible hospitals will continue to participate in the Medicare EHR Incentive Program, as usual, with the exception of some requirement changes. The 2018 Medicare Hospital Inpa...
In CMS
Feb 2nd, 2018
Expanded packaging, off-campus provider-based department changes, and 340B are at the top of the list. Using Hospital Outpatient Prospective Payment System (OPPS) methodology, the Centers for Medicare & Medicaid Services (CMS) based 2018 OPPS payments on claims data submitted by hospital providers, resulting in an estimated 1.35 percent increase. Hospitals that fail to meet the ...