CMS recently published a summary of its third quarter 2023 HCPCS Level II code update application decisions, accepting 51 of 61 submissions. There were also 10 codes that will be discontinued and one code whose definition will be revised. The additional codes mostly consist of injections and skin substitutes.
Approximately 33% of patients who experienced a first-time atrial fibrillation (AF) episode while hospitalized for noncardiac reasons had additional AF episodes up to one year after being discharged, according to a study recently published in the Annals of Internal Medicine .
CMS estimated $4.4 billion in improper payments in 2022 for hospital outpatient services, according to a Comprehensive Error Rate Test review recently published in the Medicare Provider Compliance Newsletter. According to the report, of the 1,899 inspected claims, 5.4% were improperly paid.
A recent Office of Inspector General report found that CMS paid $41.4 million in improper payments to acute care hospitals for claims that were assigned incorrect discharge status codes.
CMS' recently implemented October OPPS update brings with it a slew of new, revised, and deleted CPT and HCPCS Level II codes with effective dates ranging from April 18 to October 1. Among the additions are codes for vaccines, vaccine administration, skin substitutes, renal histotripsy, and breast imaging.
CMS recently published an infographic that defines social determinants of health (SDOH), explains the significance of capturing them, and lists which SDOH codes will go into effect October 1.
AMA published the 2024 CPT code set with 349 total editorial changes, including 230 additions, 49 deletions, and 70 revisions. The press release announced revisions for immunization/administration sections, E/M clarification, and new Spanish procedure descriptions.
A Journal of Hospital Medicine study published online in August found that decreases in readmission associated with CMS’ Hospital Readmission Reduction Program (HRRP) correlated with an increase in patient mortality for certain conditions.
CMS updated its E/M Services Guide in August, reflecting changes for E/M services that went into effect January 1. The guide includes plain-language explanations of policy changes, but some do not align perfectly with AMA guidance.
The Centers for Disease Control and Prevention (CDC) announced the launch of its Hospital Sepsis Program Core Elements initiative on August 24. The program offers resources for hospitals to improve identification and management of sepsis.
CMS recently released a national coverage determination update to the Medicare Claims Processing Manual . This update covers new requirements for CPT coding associated with acupuncture and dry needling services.
CMS recently published a summary of its second quarter 2023 HCPCS Level II code update application decisions, accepting 16 of 24 submissions. Many of the changes addressed in the announcement have an effective date of October 1, but one code revision and one code discontinuation will take effect before then.
A July JAMA Network study found that cannabis use disorder slightly increased patient morbidity and in-hospital mortality. The study included 12,422 hospitalizations following major elective inpatient surgeries.
CMS published the 2024 Medicare Physician Fee Schedule (MPFS) proposed rule on July 13 with new potential policies and codes affecting physician reporting, including new HCPCS codes for E/M services and behavioral health.
A recent study from Epic Research showed that the average length of provider notes increased, but note-taking time decreased since 2020. The study explains the reason for this change and the effect it has on providers.
A June study in The Journal of the American Medical Association concluded that data collection and reporting efforts to comply with CMS inpatient hospital quality programs cost more than $5 million and took more than 100,000 personnel hours for a large hospital.
The Office of Inspector General (OIG) recently released the results of an audit of Medicare billing requirements for psychotherapy services submitted from March 2020 through February 2021 as providers adapted to changes introduced as a result of the COVID-19 public health emergency.
CMS’ FY 2024 ICD-10-PCS codes, guidelines, and conversion table were published June 6. The release featured minor guideline changes, 78 new codes, 14 revisions, and five deletions.
CMS released Transmittal 12053 in May, outlining CMS’ intended changes in the July 2023 OPPS update. The new HCPCS codes will be used to report gastric procedures, insulin pump equipment, echocardiography processing, and more.
CMS recently published an MLN Fact Sheet that explains how providers can check Medicare claim status information. This quick reference guide also offers pointers on establishing an NPI, monitoring claims, when to check claims’ payment statuses, and more.
Revenue cycle leaders reported denials management as their most time-consuming revenue cycle task, followed by prior authorizations, according to a new survey by AKASA.
CMS published its first quarter 2023 HCPCS Application Summaries and Coding Recommendations April 27, which summarizes the final decisions on HCPCS Level II code assignments. CMS created 58 new HCPCS codes, deleted seven codes, and revised one code. Most changes will be implemented July 1.
CMS recently published its evaluation of New Technology Add-on Payment (NTAP) applications and proposed revisions to NTAP eligibility criteria in its fiscal year (FY) 2024 IPPS proposed rule.
CMS released the fiscal year (FY) 2024 IPPS proposed rule on April 10. The document contains proposals for 395 new, 12 revised, and 25 invalidated ICD-10-CM codes.
Patients with Alzheimer’s disease and related dementias have higher readmission rates than the general geriatric population, according to a retrospective cohort study published in JAMA Network Open .
The American Medical Association’s (AMA) CPT Editorial Panel recently approved a new vaccine administration code for COVID-19. It also released a summary of panel actions, which includes accepted and deleted code and guideline revisions for July 2023, January 2024, and January 2025.
CMS released the fiscal year (FY) 2024 IPPS proposed rule on April 10, 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 reducing health equity gaps.
CMS has published CPT and HCPCS Level II updates that take effect in April. Review highlights of the code and modifier changes in the April 2023 HCPCS Level II and OPPS updates.
Nearly 80% of healthcare organizations are collecting data on social determinants of health (SDoH), or non-clinical factors that affect health, including family and home life, education, employment, and food insecurity, according to a new AHIMA survey.
CMS recently published its fourth quarter 2022 HCPCS Application Summaries and Coding Recommendations. The new codes will be used to report injections and skin substitutes and are scheduled to take effect April 1.
The HCPCS first quarter 2023 update, released in December, introduced several new codes and modifiers for medical products and procedural services. Most of the changes took effect January 1.
Postoperative mortality rates among Medicare beneficiaries are associated the characteristics of patients’ neighborhoods and the hospitals where they received treatment, according to a study published in JAMA Network Open in January.
CMS recently published an FAQ document on the use of drug waste modifiers. The resource addresses how the modifiers affect Medicare policy, to which products they can be appended, billing concerns, and more.
The CPT Editorial Panel released 20 new Category III CPT codes. These new codes, along with two revisions, are mainly for cardiovascular procedures and take effect July 1.
The Office of Inspector General (OIG) recently released its annual report detailing its list of top unimplemented recommendations for 2022. The agency recommends that CMS increase scrutiny of inpatient hospital claims for severe malnutrition and other diagnoses that are vulnerable to upcoding.
The Centers for Disease Control and Prevention and the National Center for Health Statistics published updates to the ICD-10-CM coding guidelines and files, which take effect April 1. The updates include 42 new diagnosis codes, seven deletions, and one revision.
A retrospective medical record review published in JAMA Network Open in December found that nearly one-third of intentional firearm injuries resulting in emergency department admissions were inaccurately coded in ICD-10-CM as accidents.
CMS recently released Transmittal 11737, detailing January 2023 updates to the OPPS. The transmittal offers information on new COVID-19 vaccine and administration codes, dental coding updates, coding clarification, and remote behavioral health service codes.
CMS recently released Medicare Claims Processing Transmittal 11685 revising language to make three revenue codes for inpatient hospital services allowable for payment under Medicare Part B and adding COVID-19 to its list of preventive services.
The CPT Editorial Panel recently announced that it approved new CPT codes for Pfizer’s bivalent COVID-19 vaccine booster and its administration for children six months to 4 years old after they have received administration of the first and second doses of the product.
The average patient length of stay in hospitals has increased by 19.2% in 2022 compared to 2019 levels, the American Hospital Association said, citing data from Strata Decision Technology. For patients awaiting discharge to post-acute care settings, the increase is nearly 24%.
The Office of Inspector General (OIG) recently released a report investigating instances of incorrect co-surgery and assistant-at-surgery modifier usage, which found that 69 of 100 sampled procedural services did not meet federal requirements.
Coded housing instability is linked to higher hospital admission rates for mental disorders, longer inpatient stays, and substantial healthcare costs, according to a study recently published in JAMA Network Open .
The severity and length of post-COVID-19 symptoms has been a topic of study almost ever since the pandemic began. In a new study involving patients with significant respiratory disability following hospitalizations for COVID-19, daily supervised pulmonary rehabilitation was associated with significant improvement in exercise tolerance and quality of life.
CMS released its 2023 OPPS final rule on November 1. The document finalizes most proposed policies, including a new provider type for rural emergency hospitals (REH), continued coverage of telehealth services, and implementation of new skin substitute HCPCS codes, among other changes, which largely take effect January 1, 2023.
As the shift to outpatient care has accelerated, likely due to COVID-19, inpatient volumes continue to remain below pre-pandemic levels for hospitals and health systems this year, according to Kaufman Hall’s 2022 State of Healthcare Performance Improvement report.
The Office of Inspector General (OIG) released a report in October to assess the results of 12 Medicare hospital and identify CMS’ actions as a result of OIG recommendations made in those audits.
A recent medical record review published in the Journal of the American Medical Association Network Open found that between October 1, 2021, and January 31, 2022, providers used ICD-10-CM code U09.9 (post-COVID-19 condition, unspecified) to identify a multitude of post-acute conditions brought on by COVID-19.
CMS recently published Transmittal 11594 , outlining HCPCS codes for drugs that received pass-through status, new proprietary laboratory analysis (PLA) codes for tests, code revisions for pharmaceutical drugs, and skin substitute product codes, all of which became effective October 1.
