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CMS recently released the fiscal year (FY) 2022 IPPS final rule, which repealed the MS-DRG relative weight methodology finalized in the FY 2021 IPPS final rule.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 Along with payment rate updates, the final rule also repealed the MS-DRG relative weight methodology and hospital cost-reporting requirement finalized in the 2021 IPPS final rule.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.
Billing for high-level inpatient stays increased over a six-year period sparking concerns by the government about upcoding, according to a recent report from the Office of Inspector General (OIG).
Physician and non-physician practitioners may benefit from reviewing documentation requirements and HCPCS Level II codes for knee orthoses, according to a recent Medicare Quarterly Compliance Newsletter .
The American Medical Association’s (AMA) CPT Editorial Panel at its February meeting approved technical corrections to the E/M coding guidelines for outpatient visits. The corrections were uploaded to the AMA website on March 9 and go into effect retroactively from January 1.
COVID-19 patients who were hospitalized as inpatients cost significantly more than those treated in an outpatient setting, according to data from the Blue Cross and Blue Shield Association.
CMS recently added six codes to the list of services that may be reported with HCPCS modifier -CS (cost-sharing), which requires Medicare to cover beneficiary cost-sharing during office visits and other encounters for the duration of the COVID-19 public health emergency.
According to a study recently published in the Journal of Clinical Endocrinology & Metabolism , 55% of Black patients with both COVID-19 and Type 1 diabetes also presented with diabetic ketoacidosis.
The Food and Drug Administration (FDA) recently issued an emergency use authorization (EUA) for the combination treatment of bamlanivimab and etesevimab for COVID-19 patients at high risk for severe infection.
CMS is modifying its approach for presenting new technology add-on-payment-related ICD-10-PCS code requests that involve the administration of therapeutic agents for its March 9-10, 2021 ICD-10 Coordination and Maintenance Committee meeting.
The Office of Inspector General (OIG) recently released an audit report for Providence Medical Center that says some of the hospital’s inpatient records did not support the medical necessity for inpatient hospital services.
A recent analysis of electronic health record data from 2015 to 2019 shows that providers underreported ICD-10-CM codes in categories Z55-Z65 for social determinants of health.
Those afflicted with sickle-cell disease or sickle cell traits were more likely to experience severe COVID-19 illness and hospitalization, according to a recent study presented at the American Society of Hematology Annual Meeting and Exposition.
The January 2021 quarterly update to the OPPS , released by CMS December 31, announces new HCPCS codes for vitrectomy, nasal endoscopy, and intravascular lithotripsy procedures. The update also...
Almost half of hospitals in the U.S will be getting lower payments for Medicare patients due to their readmissions history, according to a recent analysis reported in Kaiser Health News.
CMS recently announced that it will take steps to increase hospital capacity by allowing care to be provided to patients outside a traditional, inpatient hospital setting amid a rising number of COVID-19 hospitalizations.
CMS recently announced 27 new ICD-10-CM and ICD-10-PCS codes, along with corresponding MS-DRG assignment, for diagnoses and procedures related to COVID-19. These new codes will become effective for discharges on or after January 1.
The Office of Inspector General (OIG) recently announced it plans to audit hospital inpatient claims. According to the report, the OIG wants to determine if inpatient claims with short lengths of stay were incorrectly billed as inpatient when they should have been billed as outpatient or outpatient with observation.
The American Medical Association (AMA) on November 10 announced a handful of new CPT codes for reporting COVID-19 vaccine products and immunization administration.
Incorrect acute stroke diagnosis codes reported by Medicare providers resulted in millions of dollars in increased payments to Medicare Advantage organizations, according to a recent Office of Inspector General (OIG) report.
CMS on October 28 released an interim final rule that ensures physician reimbursement for the administration of a COVID-19 vaccine and outpatient hospital reimbursement for COVID-19 drug services provided at the same time as a comprehensive APC service.
Encephalopathy affects nearly one in three novel coronavirus (COVID-19) patients, according to a recent study published in the Annals of Clinical and Translational Neurology.
According to The Office of Inspector General’s (OIG) recent Work Plan update, it will be reviewing payments for COVID-19 discharges that grouped to the newly weighted COVID-19 MS-DRGs.
Baylor Scott & White-College Station didn't properly bill Medicare for supplemental outlier payments, according to a September Office of Inspector General (OIG) report. Reviewed claims contained errors due to overcharging and inaccurate coding, resulting in $189,276 in overpayments, said the report.
CMS recently released the FY 2021 IPPS final rule, which increased hospital payment rates, created new MS-DRGs, and finalized the FY 2021 ICD-10-CM/PCS code sets and CC/MCC designations to be implemented October 1.
The American Medical Association (AMA) on September 8 published two new CPT codes for novel coronavirus (COVID-19)-related services, including one that accounts for additional supplies and clinical staff time used to mitigate the spread of the virus.
CMS recently released guidance stating that for inpatient novel coronavirus (COVID-19) claims, a positive viral test result is now required in order to be eligible for the 20% increase in the MS-DRG weighting factor. This became effective for all admissions on or after September 1.
The 2021 MPFS proposed rule, released August 3, introduces new policies under the Quality Payment Program (QPP) including plans to delay implementation of the Merit-based Incentive Payment System Value Payment (MVP) model and introduce 108 new quality measures.
