CMS published a notice in the Federal Register on August 9 stating that it will be suspending prior authorization requirements for specific durable medical equipment, prosthetics/orthotics, and supply (DMEPOS) codes under certain circumstances, beginning January 1, 2023. All claims submitted before that date will require prior authorization documentation.
A recent audit conducted by the Office of Inspector General (OIG) found that Cariten Health Plan Inc. in Knoxville, Tennessee, received at least $9.2 million in net overpayments from 2016 to 2017 for incorrectly submitting selected high-risk diagnosis codes.
The American Medical Association (AMA) released the Category I vaccine product codes for monkeypox tests and vaccines. The organization made them effective immediately upon their approval by the CPT Editorial Panel on July 26. The new codes are scheduled to appear in the in the 2024 CPT Manual.
CMS released the fiscal year (FY) 2023 IPPS final rule on August 1, increasing hospital payment rates by 4.3% and establishing three health equity-focused measures in hospital quality programs.
Q: When would you report an ICD-10-CM code from category I22 (subsequent ST elevation and non-ST elevation myocardial infarction [MI]) with a code from I21 (acute MI)?
The current year (CY) 2023 OPPS proposed rule, released July 15, details hospital payment updates, remote behavioral services, and enrollment requirements for rural emergency hospitals, among other proposals.
Twenty-five percent of hospitalized Medicare patients experience patient harm, and 43% of those harm events could have been prevented, according to a recent Office of Inspector General (OIG) report.
The American Medical Association’s (AMA) CPT Editorial Panel recently published changes to its E/M Services Guidelines. The update includes code revisions, additions, and deletions, which are scheduled to take effect January 1, 2023.
Peoples Health Network received an estimated $3.3 million in overpayments between 2015 and 2016 for incorrectly billing ICD-10-CM codes from high-risk groups, according to a recent audit by the Office of Inspector General (OIG).
The Centers for Disease Control and Prevention recently released the fiscal year (FY) 2023 ICD-10-CM code set and ICD-10-CM Official Guidelines for Coding and Reporting , introducing new codes and guidance for reporting dementia, head injuries, and long-term drug therapy.
CMS recently announced that it released a new HCPCS Level II code for AstraZeneca's EVUSHELD COVID-19 antibody treatment, effective for dates of service on or after February 24. The initial dose authorized for use during the public health emergency has been changed to 600 mg for pre-exposure prevention of COVID-19.
CMS recently released the fiscal year (FY) 2023 ICD-10-PCS code set and ICD-10-PCS Official Guidelines for Coding and Reporting . The ICD-10-PCS update includes several new codes for Destruction and Occlusion, and a new guideline for Detachment procedures of the extremities.
The establishment of mandatory sepsis protocols at all hospitals in New York state is estimated to have saved more than 16,000 lives between 2015 and 2019, according to End Sepsis.
The American Medical Association (AMA) recently announced an editorial update to the CPT code set for COVID-19 vaccines that includes new codes for Pfizer-BioNTech’s booster vaccine and Sanofi-GlaxoSmithKline’s (Sanofi-GSK) vaccine candidate.
Hospitalists coded a significantly higher proportion of Medicare beneficiaries as high severity compared to non-hospitalists, according to a study published in the Journal of the American Medical Association Health Forum .
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 .