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 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 ...
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 ...