CMS released four new resources in early April on the Merit-based Incentive Payment System, one of two new payment options under the Quality Payment Program initiative created by the Medicare Access and CHIP Reauthorization Act.
Audited hospitals generally applied modifier -59 (distinct procedural service) incorrectly when billing for outpatient right heart catheterizations and heart biopsies provided during the same encounter, leading to overpayments totaling approximately $7.6 million, according to a March report from the Office of Inspector General.
CMS released a new educational initiative , Connected Care , on March 15 to help raise awareness of the benefits of chronic care management services, as Medicare has recently added and started paying for these services.
On March 8, CMS released eight frequently asked questions (FAQ) related to the Medicare Outpatient Observation Notice (MOON). The FAQs reinforce that psychiatric hospitals must comply with the Notice of Observation Treatment and Implication for Care Eligibility Act and MOON.
A study conducted by Journal of American Medical Association (JAMA) based on data obtained from the 2013 Nationwide Readmissions Database, revealed that sepsis accounts for a higher rate of unplanned readmissions than the other studied medical conditions.
Radiation oncology services billed to CMS had a 9.6% improper payment rate in 2015, leading to Medicare improperly paying $137 million for these services, according to a study reported in the January 2016 Medicare Quarterly Compliance Newsletter .
In January, the Society of Critical Care Medicine and the European Society of Intensive Care Medicine released the 2016 Surviving Sepsis guidelines, adopting the new consensus definitions for sepsis and septic shock (Sepsis-3) established last year.
A Comprehensive Error Rate Testing study showed insufficient documentation caused most improper payments for facet joint injections, according to the January 2016 Medicare Quarterly Compliance Newsletter .
Hospital-acquired conditions (HAC) declined by 21% between 2010 and 2015, saving an estimated 125,000 lives and $28 billion in health care costs, according to preliminary results published by the Agency for Healthcare Research and Quality .
Insufficient documentation caused most improper payments for retinal photocoagulation payments reviewed in a Comprehensive Error Rate Testing study, according to the January 2016 Medicare Quarterly Compliance Newsletter.
Late in 2016, CMS finalized three bundled payment models focusing on cardiac care and another for orthopedic care, while also updating aspects of the Comprehensive Care for Joint Replacement (CJR) Model introduced in April 2016.
CMS recently made an administrative settlement process available for inpatient status claims. This process is open to eligible hospitals willing to withdraw pending appeals in exchange for a timely partial payment, or 66% of the net allowable amount, CMS said in the statement.
Last week, CMS released an updated version of the Medicare Outpatient Observation Notice (MOON), which stated that effective March 8, 2017, hospitals will be required to present the MOON advisory in writing and verbally to Medicare beneficiaries who receive at least 24 hours of hospital services under outpatient status.
CMS made no changes for quality measures related to 2019 payment determinations that require reporting next year in the 2017 OPPS final rule. However, for payment determinations in 2020 and subsequent years, CMS is finalizing proposals on seven quality measures.