CMS and the Office of Inspector General (OIG) claims to have identified unspecified upcoding in hospital billing—either accidentally or intentionally reporting higher severity codes than supported by documentation to increase payment. Because of this, these entities will conduct a two-part study to assess inpatient hospital billing, according to the OIG.
CMS recently released the 2019 NCCI Policy Manual for Medicare Services , which includes updates to payment policies and coding methodologies effective January 1, 2019. The changes impact billing and reporting for spinal arthrodesis procedures and laboratory services.
Among patients ages 65 years and older, the rate of opioid-related hospitalizations increased more than the rate of nonopioid-related hospitalizations between 2010 and 2015, according to the recent statistical brief published by the Healthcare Cost and Utilization Project.
Findings from an Office of Inspector General (OIG) audit show that Novitas Solutions Inc. overpaid hospitals for intensity-modulated radiation therapy (IMRT) services provided to nearly all sampled Medicare beneficiaries over a 30-month period, resulting in overpayments of at least $7.2 million.
A new risk model provides a simple way to determine whether acute myocardial infarction (AMI) patients are at a high risk for hospital readmissions, says a study published in the Journal of the American Heart Association.
CMS recently released both the calendar year (CY) 2019 Medicare Physician Fee Schedule and OPPS final rules last week, revising the payment structure for E/M office visits and expanding payment reductions for drugs purchased under the 340B discount pricing program by nonexcepted, off-campus, provider-based departments.
CMS released Transmittal 836 on October 19, clarified language in Chapter 6 of the Medicare Program Integrity Manual regarding medical review of diagnostic laboratory tests.
The rate of most hospital-acquired conditions (HAC) continued to decline from 2014 to 2016, according to the latest national scorecard released by the Agency for Healthcare Research and Quality.
A retrospective study recently published in the Journal of Pediatric Surgery found that 59% of reviewed cases across four institutions contained discrepancies between operative dictation and CPT coding for pediatric abdominal surgeries.
Acute heart failure patients in an emergency department's clinical pathway program had a 13.1% lower readmission rate, according to a report published in the American Journal of Emergency Medicine.
The most recent quarterly update to the influenza virus vaccine code set includes a new HCPCS influenza virus vaccine code approved for use in 2019, according to CMS Transmittal 4127.
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).
