CMS’ recently released fiscal year (FY) 2023 IPPS proposed rule includes 1,179 proposed ICD-10-CM code additions, mainly affecting reporting for dementia, concussions, and injuries due to motor vehicle collisions. The code changes, if finalized, would take effect October 1, 2022.
CMS released the fiscal year (FY) 2023 IPPS proposed rule on April 18, with proposals for the annual ICD-10-CM/PCS code update and increases to hospital payment rates. The rule also introduces new quality measures aimed at advancing health equity and improving maternal health outcomes.
A New York City provider received an estimated $1.1 million in Medicare overpayments for behavioral health services that did not comply with billing requirements, according to a recent Office of Inspector General (OIG) report.
A recent audit conducted by the Office of Inspector General (OIG) projected that hospitals received $47.8 million in net overpayments from January 2018 through July 2019 for Medicare Part A claims that did not meet national requirements or contractor specifications for bariatric surgery.
CMS recently released an update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) edit files, introducing more than 4,000 new CPT code pairs. The PTP edits took effect April 1 and primarily involve codes found in the pathology and laboratory section of the CPT Manual .
CMS recently released three ICD-10-PCS codes, effective April 1, for the administration of fostamatinib (Tavalisse®)—an oral spleen tyrosine kinase inhibitor used to treat adults with low platelet count due to chronic immune thrombocytopenia.
Following the release of the Medicare Payment Advisory Commission’s March report to Congress, the American Medical Association (AMA) urged Congress to revise the Medicare Physician Fee Schedule (MPFS) to include stable, annual payment updates that keep up with inflation and practice costs.
A recent audit conducted by the Office of Inspector General (OIG) found that Tufts Health Plan Inc. (Tufts) received at least $3.7 million of net overpayments from 2015 to 2016 for incorrectly submitting selected high-risk diagnosis codes.
CMS recently announced a new HCPCS Level II code for COVID-19 convalescent plasma administered in the outpatient setting, effective for claims submitted on or after December 28, 2021.
The American Medical Association (AMA) recently announced three new CPT codes for administration of Pfizer’s COVID-19 vaccine in children 6 months to under 5 years old.
The Office of the Inspector General (OIG) recently announced it will conduct statewide reviews to determine whether hospitals complied with Medicaid billing requirements when assigning severe malnutrition diagnosis codes to inpatient hospital claims.
CMS recently issued a new HCPCS code for the antiviral medication remdesivir when administered in the outpatient setting. The new code is a response to a statement from the National Institutes of Health regarding therapies for the COVID-19 omicron variant.
CMS recently released two ICD-10-PCS codes, effective April 1, to describe the introduction or infusion of therapeutics, including vaccines for COVID-19 treatment.
The American Medical Association (AMA) recently announced that it updated the CPT code set to include a new code for a third dose of Pfizer’s COVID-19 vaccine in children 5 through 11 years old.
The Centers for Disease Control and Prevention (CDC) recently released multiple addenda with new tabular and index instructions and updates to the ICD-10-CM Official Guidelines for Coding and Reporting to complement the updated ICD-10-CM code set to become effective April 1.
Between 2016 and 2019, Medicare payments to laboratories for genetic tests quadrupled from $351 million to $1.41 billion. This sharp increase in spending on genetic testing is likely linked to excessive and fraudulent billing, according to a recent Office of Inspector General (OIG) report.
The fall 2021 Leapfrog Hospital Safety Grade report has been released, assigning grades to 2,901 hospitals. The grades come from hospitals’ performance on over 30 evidence-based measures of patient safety. For the first time, a new grading factor for post-operative sepsis, blood leakage, and kidney injury were included in those measures.
The Office of Inspector General (OIG) recently released the 2021 version of its annual publication on unimplemented recommendations, which lists overpayments from incorrectly assigned severe malnutrition diagnosis codes as a top concern.
Between January 2019 and August 2020, CMS overpaid physicians an estimated $9.5 million in unallowable Medicare payments associated with facet joint denervation procedures, according to a recent Office of Inspector General (OIG) report.
CMS and the Centers for Disease Control and Prevention recently released new ICD-10-CM/PCS codes related to vaccines and treatments for COVID-19. These new ICD-10-CM/PCS codes are effective April 1, 2022.
Effective January 1, CMS is expanding coverage for the use of telehealth technology to include the delivery of mental health services in underserved areas.
According to a recent audit performed by the Office of Inspector General (OIG), Coventry Health Care of Missouri Inc. received nearly half a million dollars in overpayments from 2014 through 2016 for incorrectly submitting diagnosis codes from high-risk groups.
CMS recently released the 2022 Medicare Physician Fee Schedule (MPFS) and OPPS final rules, revising E/M coding guidelines for split visit services, retaining Category 3 telehealth codes through 2023, and increasing monetary penalties for hospital price transparency noncompliance.
The Office of Inspector General (OIG) recently announced its intention to publish a toolkit for identifying adverse events through medical record reviews for inpatient hospitals. The OIG plans to have the toolkit published in fiscal year 2022.
The American Medical Association (AMA) recently announced that it updated the CPT code set to include a new code for a booster dose of Johnson & Johnson’s Janssen COVID-19 vaccine.
The Surviving Sepsis Campaign recently released a 2021 update to guidelines for the care of patients with sepsis. The updated guidelines emphasize the difficulties with treating patients who are experiencing long-term effects of sepsis.
Between 2016 and 2017, CMS overpaid hospitals and other providers an estimated $636 million in unallowable Medicare payments associated with neurostimulator implantation surgeries, according to a recent Office of Inspector General (OIG) report.
The October 2021 quarterly update to the OPPS announces new HCPCS codes for endoscopic submucosal dissection and central venous catheterization. It also introduces new HCPCS drug codes and revisions to the list of those qualifying for pass-through payment status.
CMS recently released the FY 2022 IPPS final rule, which finalized updates to quality programs including the Hospital-Acquired Condition Reduction Program, the Hospital Readmissions Reduction Program, and the Hospital Value-Based Purchasing Program.
John Peter Smith Hospital in Tarrant County, Texas, has agreed to pay $3.3 million to settle allegations that it was in violation of the False Claims Act by upcoding certain claims.
CMS recently released the fiscal year (FY) 2022 IPPS final rule, which repealed the MS-DRG relative weight methodology finalized in the FY 2021 IPPS final rule.
CMS overpaid physicians an estimated $1.7 million for transitional care management (TCM) services over a two-year period, according to a recent Office of Inspector General (OIG) report. Overpayments were due to CPT coding and billing errors.
Medicare overcompensated providers for complex and noncomplex chronic care management (CCM) services billed over a two-year period, according to a recent OIG report. These overpayments occurred because CMS did not have claim edits in place to prevent billing of overlapping care management services.
The Office of Inspector General (OIG) recently released its fiscal year (FY) 2020 Healthcare Fraud and Abuse Control Program report. During FY 2020, the federal government won or negotiated more than $1.8 billion in healthcare fraud judgments and settlements, according to the report.
The American Medical Association (AMA) recently announced that it updated the CPT code set to include new codes for third doses of the Moderna and Pfizer/BioNTech COVID-19 vaccines.
CMS released the fiscal year (FY) 2022 IPPS final rule on Monday, August 2, which finalizes its efforts to cushion the ongoing impact of the COVID-19 pandemic on hospital revenue and resources. Along with payment rate updates, the final rule also repealed the MS-DRG relative weight methodology and hospital cost-reporting requirement finalized in the 2021 IPPS final rule.
The fiscal year (FY) 2022 ICD-10-CM and ICD-10-PCS Official Guidelines for Coding and Reporting, both effective October 1, were recently released by the Centers for Disease Control and Prevention and CMS, respectively.
Staten Island University Hospital overcharged Medicare an estimated $11.8 million for inpatient and outpatient services billed over a two-year period, according to a recent Office of Inspector General (OIG) report.
The Centers for Disease Control and Prevention recently released the fiscal year (FY) 2022 ICD-10-CM code set which includes 159 new, 20 revised, and 32 deleted ICD-10-CM codes. CMS also released the finalized ICD-10-PCS codes for FY 2022, which includes 191 new, 62 revised, and 107 deleted ICD-10-PCS codes. The code changes take effect October 1, 2021.
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.
University of Michigan Health System overcharged Medicare an estimated $12.5k for polysomnography services submitted over a two-year period, according to a recent Office of Inspector General (OIG) report. Overpayments were due to insufficient documentation and CPT coding errors.
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.
CPT codes 63685 and 63688 for spinal neurostimulator procedures have been removed from the list of services that would require Medicare prior authorization when performed in a hospital outpatient department, CMS announced on May 13.
The Office of Inspector General (OIG) performed a provider compliance audit of the Virtua Our Lady of Lourdes Hospital and found that the hospital received overpayments of approximately $4.8 million between January 1, 2016 and December 31, 2017.
The American Medical Association (AMA) recently updated the CPT code set to include immunization and administration codes for a COVID-19 vaccine under development by Novavax Inc.
CMS’ recently released fiscal year (FY) 2022 IPPS proposed rule includes 153 proposed ICD-10-CM code additions, mainly affecting reporting for immune effector cell-associated neurotoxicity syndrome, gastric intestinal metaplasia, and poisonings by cannabis and synthetic cannabinoids.
A Humana health plan in Florida collected nearly $200 million in Medicare overpayments in 2015 by improperly coding for high-severity Hierarchical Condition Category conditions, according to a recent audit from the Office of Inspector General (OIG).
CMS recently added 24 audiology and speech-language pathology services to its list of telehealth services covered under Medicare during the COVID-19 public health emergency (PHE). These services include speech, hearing, and swallowing assessments, and cognitive interventions.