CMS implemented the FY 2025 IPPS final rule on October 1, which introduced several updates to New Technology Add-on Payment designations, directly affecting how inpatient services are coded and reimbursed. Follow Judith Kares, JD , as she reviews NTAP eligibility criteria and payment strategies, alternative pathways for approval, final new technologies, and application process changes. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Certain diagnosis-related groups (DRGs) remain vulnerable to audits and denials, not only for DRG and clinical validation, but for medical necessity as well. Kim Conner, BSN, CCDS, CCDS-O , explores areas coding professionals can support when being proactive against these denials.
Denials continue to be a pain point and significant challenge for every hospital across the nation, but Angelica Cage, MBA, BSN, RN, CCDS, CCS, CDIP , provides denial-proofed queries to show how establishing a diagnosis that is strongly supported by the available clinical evidence can reduce or eliminate clinical doubt with respect to the treated condition.
Medicare patients who qualify for the new preventive service designed to protect them from HIV will be eligible for up to eight counselling and screening services a year, according to a recently released CMS national coverage determination.
CMS may have major changes in store for outpatient hospital reimbursement and compliance, according to the 2025 Outpatient Prospective Payment System proposed rule. The proposed rule, released in July, includes potential changes to payment, coding, and billing for hospital outpatient services.
CMS recently announced updates to the January 2025 Integrated Outpatient Code Editor, including new HCPCS codes and changes to a handful of status indicators.
