CMS released updated I/OCE specifications in January with several changes that could require providers to examine claims submitted early in 2015 that include comprehensive APCs (C-APC) to ensure proper payment.
William E. Haik, MD, FCCP, CDIP, a practicing pulmonologist and director of DRG Review, Inc., in Fort Walton Beach, Fla., says he first became interested in coded data in 1986 after a local newspaper published his hospital’s costs, length of stay, and mortality rates for simple pneumonia. At the time, he was the only pulmonologist in the local area. The patients he treated were often those with multiple comorbidities as well as gram-negative bacterial pneumonia who had been transferred from two smaller facilities in the county.
Many coders rely on the AHA's Coding Clinic advice to resolve sticky situations with ICD-9-CM coding. However, AHA will not be transitioning its current guidance to ICD-10-CM. Instead, in January 2014, AHA began focusing solely on ICD-10-CM questions to help clear up confusion prior to implementation.
While the digestive and integumentary sections had extensive edits in the latest CPT ® update, many sections were left relatively unchanged. Joanne Schade-Boyce, BSDH, MS, CPC, ACS , and Denise Williams, RN, CPC-H, review which sections only had minor updates and take a closer look at evaluation and management and chemodenervation changes in the 2014 CPT Manual.
Nearly 75% of participating hospitals nationwide with RA activity reported receiving at least one underpayment determination, according to the AHA RACTrac survey, fourth quarter 2012, released in March. Sixty-nine percent of hospitals with underpayment determinations cited incorrect MS-DRG as a reason for the underpayment.
When CMS introduced the -X{EPSU} modifiers in August 2014 to be used in specific instances to replace modifier -59 (distinct procedural service), the agency encouraged "rapid migration" to the new modifiers.
In part two of a series, Shelley C. Safian, PhD, CCS-P, CPC-H, CPC-I, explains how to identify various types of viral skin infections and how reporting for them will change in ICD-10-CM.
The three-day payment window has been wrought with compliance challenges since its inception. In January, CMS updated the policy to provide additional clarification.
The policies that CMS publishes each year in the OPPS proposed rule don't always come as a surprise. Sometimes, CMS will announce its future intent in a previous rule in order to notify providers about data it is looking at or requesting comments on.
Jugna Shah, MPH, and Valerie A. Rinkle, MPA, examine the 2014 OPPS Final Rule and explain which services are now packaged, including drugs and biological that function as supplies when used in diagnostic or surgical procedures, clinical diagnostic lab tests, and device removal procedures.
