With the inpatient-only (IPO) list set to be phased out, HIM departments need to prepare for the larger operational and financial impacts. Consider how these changes will affect your organization.
Medicare Recovery Auditors will review claims submitted by inpatient psychiatric facilities to ensure that billed services are medically reasonable and necessary, according to a recent Medicare Quarterly Provider Compliance Newsletter.
Howard Rodenberg, MD, MPH, CCDS , describes how internal reviews can be used to identify repeated coding errors and prevent payment penalties due to Patient Safety Indicators (PSI) and hospital-acquired conditions (HAC).
Joe Rivet, Esq, CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO , summarizes findings from recent Office of Inspector General audits that highlight improper billing of high-level inpatient stays. He also outlines steps hospitals can take to prevent billing errors due to upcoding.
Approximately 1.5% of the general population sees a primary care physician each year for treatment of chest pain symptoms, according to Family Practice . In this article, Sarah Nehring, RHIT, CCS, CCDS , breaks down potentially confusing ICD-10-CM coding guidelines for chest pain and angina. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
The Office of Inspector General (OIG) recently performed a compliance audit of specific diagnosis codes billed by Anthem Community Insurance Company Inc. to CMS and found that the company submitted unsupported diagnosis codes for 123 of the 203 enrollee-years.
A recent Office of Inspector General audit estimates that Medicare improperly paid inpatient hospitals $267 million over a two-year period for transfer services incorrectly billed as discharges. Judith Kares, JD , analyzes documentation and billing rules for acute and post-acute transfers.
CMS offers hospitals some breathing room to recover from the effects of the COVID-19 pandemic in the 2022 IPPS proposed rule. Review proposed updates to complication/comorbidity (CC) and major CC classifications, and a proposed new MS-DRG rate-setting method aimed at alleviating hospital burden.
