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.
On July 30 CMS announced the addition of 12 new ICD-10-PCS codes to describe the Introduction or Transfusion of therapeutics for treating patients with COVID-19. These new codes became effective August 1.
Medicare Recovery Audit Contractors (RAC) reported that several outpatient claims did not meet medical necessity requirements for hyperbaric oxygen (HBO) therapy for diabetic wounds of the lower extremities, according to the July 2020 Medicare Quarterly Provider Compliance Newsletter .
According to a recent audit by the Department of Health and Human Services’ Office of Inspector General (OIG), Ohio State University Hospital received millions in overpayments during an audit period due to errors in coding, MS-DRG assignment, and billing.
The American Medical Association (AMA) recently announced a new CPT® code for reporting antigen testing performed on patients suspected of being infected with the novel coronavirus (COVID-19). The new code is intended to improve reporting of antigen tests using an immunofluorescent or immunochromatographic technique for detection of COVID-19.
The ICD-10-CM Coordination and Maintenance Committee recently released the fiscal year (FY) 2021 ICD-10-CM code set, which includes 490 new, 58 deleted, and 47 revised ICD-10-CM codes. Along with updates to the Tabular index, these changes include new codes for reporting chronic kidney disease and body mass index.
CMS’ recently released the fiscal year (FY) 2021 IPPS proposed rule which included proposals for the creation and revision of various MS-DRGs. In particular, CMS proposed the creation of a new MS-DRG for cases involving chimeric antigen receptor T-cell (CAR-T) therapies.
CMS recently published details on prior authorization requirements, established by the 2020 OPPS final rule, for select hospital outpatient department (HOPD) services, scheduled to go into effect July 1.
CMS recently released the fiscal year (FY) 2021 ICD-10-PCS code set and ICD-10-PCS Official Guidelines for Coding and Reporting . The ICD-10-PCS code update includes new codes for Fragmentation and Drainage, while the guidelines update includes new and revised guidelines for certain root operations, approach values, and device combinations.
CMS issued the proposed lists of new, revised, and invalidated ICD-10-CM codes May 11 in conjunction with the fiscal year (FY) 2021 Inpatient Prospective Payment System proposed rule. The update will be significantly larger than the FY 2020 ICD-10-CM update if all the proposed changes are finalized.
CMS released the fiscal year (FY) 2021 IPPS proposed rule this week, with proposals for the annual ICD-10-CM/PCS code update, the creation of new MS-DRGs, and increases to hospital payment rates.
CMS released an interim final rule with comment period on April 30 that grants organizations additional flexibilities to meet the challenges of the COVID-19 public health emergency, including permitting hospitals to bill for telehealth services and loosening restrictions on COVID-19 testing.
Providers have two new CPT codes to report for blood tests to check for the presence of COVID-19 antibodies. The codes, which allow for reporting of one- and two-step testing methods, took effect April 10, according to an American Medical Association (AMA) update.
The state of New York issued an executive order directly effecting the work of health information management professionals that limits documentation and coding requirements for COVID-19 patients. Around the same time, the U.S. Department of Health and Human Services announced it will reimburse hospitals nationwide at Medicare rates for treating uninsured COVID-19 patients.
On March 31, the CDC updated the 2020 ICD-10-CM Official Guidelines for Coding and Reporting to include guidance for reporting the novel coronavirus and associated respiratory illnesses, effective April 1 through September 30.
CMS and the Centers for Disease Control and Prevention (CDC) announced a new ICD-10-CM code for reporting COVID-19 along with relief for facilities participating in quality reporting during COVID-19. Guidance on MS-DRG assignment and CC/MCC status for the new COVID-19 code has also been released.
The AMA announced that its CPT® editorial panel expedited approval of a unique CPT code to report laboratory testing services for COVID-19. The new code supports the urgent public health need for streamlined reporting of testing for the virus.
Providers need to clean up coding for electro-acupuncture devices, according to CMS. In Special Edition MLN Matters 20001, the agency noted that some providers are incorrectly coding these devices using HCPCS Level II code L8679 (implantable neurostimulator, pulse generator, any type).
The Surviving Sepsis Campaign recently published new pediatric sepsis guidelines in Pediatric Critical Care Medicine . This update includes information on a two-phase process for septic shock and guidelines for therapy start times.
CMS announced on February 13 that it created a new HCPCS code U0001 to report laboratory testing for the 2019 novel coronavirus (COVID-19). Medicare’s claims processing system will be able to accept this code on April 1 for dates of service on or after February 4.
In 2017, roughly 48 million incident cases of sepsis were recorded worldwide and 11 million sepsis-related deaths were reported, according to a study published in The Lancet . According to the study, this represents 19.7% of all global deaths.
The Centers for Disease Control and Prevention (CDC) recently published an ICD-10-CM index and tabular addenda with reporting criteria for new ICD-10-CM code U07.0 (vaping-related disorders). The agency also updated its MS-DRG grouper software package to accommodate the new code.
CMS recently published Special Edition MLN Matters article 20004 regarding changes to new technology add-on payments (NTAP) under the IPPS that are meant to increase access to innovative antibiotics for hospital inpatients.
CMS recently rescinded Transmittal 4880, January 2020 Update of the OPPS, and replaced it with Transmittal 4494 to include updated language on the removal of procedures from the inpatient-only list and new information on out-of-pocket costs for screenings with electrocardiography. All other information remains the same.
According to the 2019 coding productivity survey recently conducted by HCPro, 36% of inpatient coders indicated that they only coded an average of one to two inpatient charts per hour.
The American Medical Association (AMA) recently published a checklist to help physician practices transition to the new E/M coding and documentation guidelines slated to take effect January 1, 2021.
Ninety percent of hospital and inpatient organization leaders are considering outsourcing both clinical and non-clinical functions to achieve cost-efficiencies and succeed in value-based care models, according to a recent Black Book survey.
Medicare made $54.4 million in improper payments to acute care hospitals for post-acute transfers that did not comply with Medicare’s policies, according to a recent report from the Office of Inspector General (OIG).
A new ICD-10-CM code for reporting vaping-related disorders will become effective April 1, 2020, the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics announced on December 9.
Safety-net hospitals may not have adequate resources to comply with federal and state sepsis quality improvement standards required of acute care hospitals, according to a recent study published in the Journal of Critical Care .
In the 2020 Medicare Physician Fee Schedule final rule, CMS proposes to adopt four new time-based HCPCS codes to be used in place of existing CPT codes for complex and non-complex chronic care management (CCM) services.
High-risk general surgery patients have greater survival rates at major teaching hospitals than at non-teaching hospitals, according to a study published by the Annals of Surgery.
