Early readmissions were more likely to be preventable and amenable to hospital-based interventions, according to a recent study published in the Annals of Internal Medicine.
The American Medical Association recently released the 2019 CPT code set, which includes 335 code changes, primarily for skin biopsies, fine needle aspirations, and central nervous system assessments. All changes take effect January 1.
The European Heart Journal recently published the fourth universal definition of myocardial infarction (MI). The newest definition, which supersedes all previous versions, includes new and updated clinical concepts as well as new sections of guidance.
The October 2018 OPPS quarterly update introduced two new HCPCS codes and granted passthrough payment status to eight separately payable drugs and biologicals.
CMS recently released the fiscal year (FY) 2019 IPPS final rule with significant reductions to reporting requirements for quality initiatives, updates to payment rates, changes to CC/MCC designations, and revisions to various MS-DRGs.
CMS and the National Center for Health Statistics recently released the 2019 ICD-10-CM Official Guidelines for Coding and Reporting. Changes include clarification on the usage of “with,” updated sepsis guidance, and added guidelines for subsequent myocardial infarction.
CMS’ 2019 OPPS proposed rule continues the agency’s efforts to enforce site-neutral payments and reduce drug payments by introducing policies to reduce reimbursement for hospital outpatient clinic visits at off-campus, provider-based departments (PBD) and expanding last year’s payment reductions for drugs purchased under the 340B discount pricing program by nonexcepted PBDs.
In June, an article detailing the upcoming release of the fourth edition of the universal definition of myocardial infarction (MI) was published in the American Journal of Medicine .
The 2019 Medicare Physician Fee Schedule (MPFS) proposed rule, released July 12, introduces policies that focus on expanding the framework for reporting E/M visits and removing certain process measures under the Quality Payment Program (QPP).
The Surviving Sepsis Campaign recently released a 2018 update to guidelines for the care of patients with sepsis. The update includes a new “hour-one bundle” which replaces previous versions of the Surviving Sepsis Campaign guidelines.
CMS exceeded its goal of 90% participation in the first year of the Quality Payment Program (QPP), according to a May blog post from CMS Administrator Seema Verma.
On June 18, the World Health Organization (WHO) released a version of the 11th Revision of the International Classification of Diseases (ICD-11). ICD-11 reflects critical advances in science and medicine and is the first code set revision to be well integrated with electronic health applications and information systems, WHO says.
The Centers for Disease Control and Prevention released the fiscal year 2019 ICD-10-CM code changes on Monday, June 11. The update includes 279 code additions, 143 revisions, and 51 deletions.
CMS has released the FY 2019 ICD-10-PCS code updates and accompanying coding guidelines. The number of ICD-10-PCS codes for 2019 will total 78,881, in comparison to the 78,705 available for FY 2018.
Despite considerable opposition from hospital systems, on June 1, the Health Resources and Services Administration finalized its decision to delay the implementation of a 340B rule on drug ceiling prices and civil monetary penalties for manufacturers.
The fiscal year (FY) 2019 IPPS proposed rule includes updates to payment rates and quality initiatives, but some of the most extensive changes pertain to MCC and CC additions and deletions.
At the 2018 American Hospital Association (AHA) Annual Membership Meeting on Monday, May 7, CMS administrator Seema Verma focused on the agency’s efforts to reduce regulatory burdens and continued move from a fee-for-service to value-based system.
CMS released the fiscal year (FY) 2019 IPPS proposed rule on Tuesday, April 24, with significant reductions to reporting requirements for quality initiatives and expected ICD-10-CM/PCS code and MS-DRG updates.
While oral arguments in the American Hospital Association’s (AHA) lawsuit against CMS for its cuts to 340B drug payments in the 2018 OPPS final rule don’t begin until May 4, providers may want to take steps now to preserve their appeal rights if the AHA’s lawsuit is successful.
Systemic inflammatory response syndrome (SIRS) criteria has a greater sensitivity than quick sepsis-related organ failure assessment (qSOFA) as a screening test to initiate treatment for sepsis in non-intensive care unit patients, according to the recent study published in the Annals of Internal Medicine.
CMS held a listening session March 21 to gather input from stakeholders on potential updates to the E/M documentation guidelines. The current guidelines are considered outdated in light of medical advances and the advent of the electronic health record.
Of emergency department visits attributable to ruptured abdominal aortic aneurysm, acute myocardial infarction, stroke, aortic dissection, and subarachnoid hemorrhage, the conditions were not accurately diagnosed approximately one out of 20 times, according to a study by the Journal of the American Medical Association (JAMA) .
In response to ongoing criticism from physicians and the government’s own advisory panel against the Medicare Access and CHIP Reauthorization Act (MACRA), the U.S. House Committee on Ways and Means Subcommittee on Health held a hearing Wednesday, March 21, to defend the administration’s implementation strategy for the new physician payment program.
An Office of Inspector General (OIG) audit of the University of Michigan Health System revealed noncompliance with four types of inpatient claims, including those associated with the billing of high-severity-level MS-DRGs.
CMS released Transmittal 3997 March 8, outlining HCPCS drug and biological code updates. These changes include updates to specific biosimilar biological product HCPCS codes, modifiers used with these biosimilar biologic products, and an autologous cellular immunotherapy treatment.
The cost for a hospital stay in 2014 involving acute renal failure (ARF) averaged $19,200, nearly twice the $9,900 average cost for stays not involving renal failure, according to the statistical brief published by The Healthcare Cost and Utilization Project (HCUP).
The World Health Organization is preparing for the official release of the 11th Revision of the International Classification of Diseases, or ICD-11, in June.
Hospitals reduced central line-associated bloodstream infections (CLABSI) by 50% between 2008 and 2016, according to a new report released by the Centers for Disease Control and Prevention (CDC).
CMS released Transmittal 3950 on January 12 describing updates to a list of the HCPCS codes for Durable Medical Equipment Medicare Administrative Contractors and Part B Medicare Administrative Contractor jurisdictions.
Only 12% of eligible hospitals signed up for CMS’ Bundled Payments for Care Improvement Model 2 initiative and 47% of them dropped out completely within two years, according to a recent study by the Journal of the American Medical Association .
Medicare fee-for-service claims had a 90.5% accuracy rate and a 9.5% improper payment rate for all claims submitted between July 1, 2015- June 30, 2016, according to a recent CMS Comprehensive Error Rate Testing report.
On January 9, CMS announced the launch of Bundled Payments for Care Improvement Advanced from the agency’s Center for Medicare and Medicaid Innovation.
With providers continuing to expand clinical documentation improvement efforts into outpatient settings, ACDIS has published a position paper offering guidance to outpatient CDI departments for performing queries.
A report released by the American Hospital Association and Manatt Health found that facilities spend approximately $39 million annually to comply with 629 requirements across nine regulatory domains.
Upon reviewing 2,145 inpatient claims at 25 providers, the Office of Inspector General (OIG) found that all but one claim incorrectly included the ICD-9-CM diagnosis code for kwashiorkor (260). This resulted in overpayments in excess of $6 million, according to the OIG report .
Recent findings support the possibility that the Hospital Readmissions Reduction Program has had the unintended consequence of increased mortality in patients hospitalized with heart failure, says a study published by JAMA .
Providers will no longer be required to append modifier -GT (via interactive audio and video) to professional telehealth claims, effective January 1, 2018, according to a policy CMS finalized in the 2018 Medicare Physician Fee Schedule (MPFS) final rule.
While the 2018 OPPS final rule may be controversial for its payment cuts to drugs purchased through the 340B drug discount program, it contains several provisions supported by hospitals and other stakeholders.
Within the span of two days last week, CMS released final rules for three comprehensive policies, which have important financial implications for hospitals, physicians, and medical professionals in 2018.
Inpatient stays involving any opioid-related diagnosis increased by 14.1% after ICD-10-CM was implemented in 2015, according to a study recently published in Medical Care .
A Comprehensive Error Rate Testing (CERT) study showed insufficient documentation causes most improper payments for arthroscopic rotator cuff repairs, according to the October 2017 Medicare Quarterly Compliance Newsletter .
On October 4, CMS issued a notice in the Federal Register containing numerous corrections to the 2018 IPPS final rule, including significant recalculations of MS-DRG relative weights and all budget neutrality factors.
The October 2017 OPPS quarterly update introduced 12 new proprietary laboratory analysis CPT codes as well as a new modifier for a biosimilar biological product.
While the Affordable Care Act has led to fewer 30-day readmissions, this reduction in readmissions does not correlate with 30-day mortality rates, according to a recent JAMA study.
As part of the October 2017 OPPS update, CMS will revise its policy on upper eyelid blepharoplasty and blepharoptosis repairs to allow physicians to receive payment for medically necessary blepharoptosis repairs when performed with cosmetic blepharoplasty.
The Centers for Disease Control and Prevention (CDC), one of the Cooperating Parties responsible for the ICD-10-CM codes and guidelines, recently released a 2018 ICD-10-CM Official Guidelines for Coding and Reporting errata. Slight changes were made to the guidelines for diabetes, hypertension, and principal diagnosis selection.
The 2018 updates to the CPT Manual released in early September feature a total of 314 code changes. New codes for E/M visits, genetic testing services, and endovascular repairs of aortic aneurysms are among the 172 additions.
The fiscal year 2018 IPPS final rule included updates to payment rates and quality initiatives, as well as an ample amount of code changes and updates to ICD-10-PCS non-OR to OR code designations.
Don’t automatically presume a link between two conditions within a combination code in cases when a guideline requires that link to be explicitly documented, the latest version of the ICD-10-CM coding guidelines clarify.
One of the most controversial changes to the 2017 ICD-10-CM guidelines was the contradictory guidance for the term “with,” and that issue is addressed in the 2018 version of the guidelines.
On Wednesday, August 2, CMS released the fiscal year 2018 IPPS final rule which featured updates to various quality initiatives, along with annual payment updates for inpatient services.
The 2018 OPPS proposed rule included potential changes to certain radiology modifiers used by CMS to identify services for data collection as well as reimbursement.
According to a study published in Annals of Emergency Medicine, researchers studying emergency department (ED) visits found that electronic sepsis alert implementation increased ED sepsis detection from 83% to 96%.
The 2018 OPPS and Medicare Physician Fee Schedule proposed rules usually make their debuts around the Fourth of July, but despite a later release this year, there were plenty of fireworks within each rule that should generate provider feedback during the comment periods.
In June, CMS released the 2018 ICD-10-PCS Official Guidelines for Coding and Reporting which include various revisions from the 2017 guidelines. These changes come on the heels of the 2018 IPPS proposed rule and recently released ICD-10-PCS codes.
On June 13, CMS released the final 2018 ICD-10-PCS codes that will become effective October 1. These changes come on the heels of April’s IPPS proposed rule.
CMS released the final 2018 ICD-10-CM codes on its website on June 13, and the release contained more code changes than expected following a preview of the new code set in April’s 2018 IPPS proposed rule.
A recent study piloted by CHEST Journal found that surveillance-based clinical data, such as electronic health records, offered more reliable estimates of septic shock trends than coded records.
CMS released a change request May 30 describing modifications which will be implemented in the July 2017 quarterly update to the OPPS. These changes include new ophthalmologic and maternal care codes as well as a handful of new drug codes.
CMS issued a change request to provide guidance to Medicare Administrative Contractors on the use of a new modifier to append to claims for dialysis treatments for end-stage renal disease exceeding the 13 or 14 monthly allowable treatments.
On April 14, CMS released the fiscal year 2018 IPPS proposed rule, which included a proposal for the discontinuation of the CardioMEMS heart failure monitoring system add-on payment.
CMS released a change request April 28 which provides guidance for Medicare Administrative Contractors on how to ensure accurate program payment for moderate sedation services provided as part of screening colonoscopies.
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.
On Friday, April 14, CMS released the fiscal year 2018 IPPS proposed rule with updates to quality initiatives and 2018 ICD-10-PCS and ICD-10-CM code proposals.
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.
Written comments on upcoming ICD-10-CM/PCS code changes presented during the ICD-10 Coordination and Maintenance Committee meeting in March are due Friday, April 7.
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.
The ICD-10 Coordination and Maintenance Committee will meet March 7-8 to discuss new conditions, procedures, and expanded details that could appear in a future update of the code set.
CMS pushed the February 15 submission deadlines for select inpatient clinical and healthcare-associated infection measure data, citing system glitches and inaccessibility to QualityNet reports.
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.
A clinical documentation improvement (CDI) team can rapidly lead to quality improvements, according to a recent survey conducted by Black Book Market Research.
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.
After missing a proposed fall start date, CMS announced last week that its Medicare Part B drug payment model from the Center for Medicare and Medicaid Innovation will not be going forward.
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.
On October 31, CMS announced that it awarded contracts to the next round of Medicare fee-for-service Recovery Auditors. The base period for contracts is 12 months from the date the contract is awarded, said CMS.
CMS released the 2017 OPPS final rule November 1, implementing site-neutral payment policies required by Section 603 of the Bipartisan Budget Act, adding new comprehensive APCs, and refining several packaging policies.
According to the recent RACTrac survey released from the American Hospital Association, 60% of claims reviewed by Recovery Auditors in the second quarter of 2016 were found to not have an overpayment.
CMS released the final rule implementing provisions of the Medicare Access and CHIP Reauthorization Act of 2015 on October 14, giving providers a timeline and outline of the quality programs and payment models that will replace the Sustainable Growth Rate and other programs.
In early August, hospitals got a last-minute reprieve from the Medicare Outpatient Observation Notice (MOON) notification requirement. CMS detailed the need for additional time to revise the standardized notification form that hospitals will need to use to notify patients about the financial implications of being assigned to observation services; and, as of now, the requirement is still in delay.
More than half of the members of Congress have written to CMS to consider changes to its proposals for implementation of Section 603 of the Bipartisan Budget Act of 2015 regarding off-campus, provider-based departments.
As providers prepare for the thousands of new codes and updated guidelines to be implemented October 1, the ICD-10 Coordination and Maintenance Committee recently met to discuss the next batch of updates to be implemented October 1, 2017.
After an almost five-month deferment, the Beneficiary and Family Centered Care Quality Improvement Organizations resumed initial patient status reviews of short stays in acute care inpatient hospitals, long-term care hospitals, and inpatient psychiatric facilities, CMS announced on their website.
CMS recently released a fact sheet regarding the coding and billing of advance care planning services, following the release of a frequently asked questions document in July on the topic.
A study conducted by Johns Hopkins Armstrong Institute for Patient Safety and Quality finds that common measures used by government agencies and public rankings to rate the safety of hospitals, such as the Agency for Healthcare Research and Quality’s patient safety indicators, and hospital-acquired conditions, do not accurately capture the quality of care provided.
CMS is proposing to replace status indicator E (services not paid, non-allowed item or service) with two more specific status indicators in the 2017 OPPS proposed rule. The agency proposes status indicator E1 for items and services not covered by Medicare and E2 for items and services for which pricing information or claims data are not available.
CMS released the fiscal year 2017 IPPS final rule August 2. ICD-10-CM/PCS code changes and the addition of the Medicare Outpatient Observation Notice had a starring role in the final rule.
