In the 2020 Medicare Physician Fee Schedule final rule, CMS increased the performance threshold for Merit-based Incentive Payment System (MIPS) eligible providers and finalized its proposal to implement the MIPS Value Pathways (MVP) framework in calendar year 2021.
CMS released the calendar year (CY) 2020 Medicare Physician Fee Schedule and OPPS final rules approving changes to E/M documentation guidelines, introducing new HCPCS codes, and continuing its potentially unlawful payment policy for drugs purchased through the 340B drug discount program.
The Centers for Disease Control and Prevention (CDC) recently released documentation guidance for providers who evaluate patients with symptoms of e-cigarette- or vaping-associated lung injury, as well as official ICD-10-CM coding guidance for reporting these encounters.
During the September ICD-10-CM Coordination and Maintenance Committee meeting, the Centers for Disease Control and Prevention (CDC) released a proposal to add, delete, and revise various ICD-10-CM codes for reporting sepsis.
The American Hospital Association, Community Oncology Alliance, and other hospital organizations expressed concerns regarding CMS’ proposed mandatory payment model for radiation oncology (RO), which if finalized, would go into effect January 1.
U.S. District Judge Rosemary M. Collyer recently ruled that CMS exceeded its authority when it expanded a site-neutral payment policy that cut reimbursement for certain E/M services provided in previously excepted off-campus hospital clinics.
CMS is finalizing its proposal to create two new MS-DRGs for endovascular cardiac valve procedures with and without MCC, according to the fiscal year 2020 IPPS final rule.
The American Medical Association released the 2020 CPT code set on August 26, introducing 248 new codes including many for drug implants, dry needling, and cardiac drainage procedures.
In August, U.S. District Judge David Ezra in Texas dismissed a case against Baylor Scott & White Health that alleged the organization falsely billed for millions in false claims for Medicare reimbursement.
In response to a formal request for information from industry stakeholders, CMS received 567 comments on ways to improve its Patients Over Paperwork Initiative, including many requests from hospital groups to simplify billing and prior approval requirements.
CMS released the FY 2020 IPPS final rule on August 2, which finalized its decision on requests for new MS-DRG designations for chimeric antigen receptor T-cell (CAR-T) therapies. Upheld from the proposed rule, CMS denied these requests.
The four organizations that make up the Cooperating Parties for ICD-10 recently approved the 2020 ICD-10-CM guidelines, which include updated guidance for reporting pressure-induced deep tissue damage, multiple drugs or medicinal substances, injuries and complications.
CMS released the fiscal year (FY) 2020 IPPS final rule on August 2 with updates to payment rates and wage index values, changes to CC/MCC designations, and revisions to various MS-DRGs. Policy updates affect approximately 3,300 acute care hospitals and apply to discharges beginning October 1.
CMS released the calendar year (CY) 2020 Medicare Physician Fee Schedule (MPFS) and OPPS proposed rules on July 29, introducing new CPT codes and extensive changes to documentation requirements for E/M office visits, and seeking commentary on how to overhaul MIPS and potentially undo its payment policy for drugs purchased through the 340B discount program.
A retrospective billing study conducted by researchers at Mayo Clinic in Jacksonville, Florida, showed that pre-existing psychiatric comorbidities independently predicted elevated healthcare costs for a large population of patients treated with radiation at the institution.
A Medicare billing study recently published in The Journal of Hand Surgery found that provider reimbursement for magnetic resonance imaging (MRI) and computed tomography (CT) scans of the upper extremities significantly decreased over the last decade.
CMS announced on June 21 that it updated the national coverage policy for transcatheter aortic valve replacement (TAVR), requiring covered hospitals and physicians to begin or maintain a TAVR program and adhere to updated volume requirements.
CMS recently released the fiscal year (FY) 2020 ICD-10-PCS changes and Official Guidelines for Coding and Reporting for the procedural coding system which will affect discharges occurring from October 1, 2019, through September 30, 2020.
The July 2019 quarterly update to the OPPS, released by CMS in late May, announces an effective date of July 1 for 20 CPT Category III codes and revises status indicators for CPT codes used to report imaging by magnetocardiography.
The estimated annual cost of sepsis readmissions is more than half the annual cost of all Medicare Hospital Readmissions Reduction Program conditions combined, according to a study published in CHEST Journal .
CMS released Transmittal 4313 on May 24 describing changes that will be implemented in the July 2019 quarterly update to the OPPS. These changes included several new HCPCS codes for reporting certain drugs and biologicals.
At a Senate Committee on Finance hearing on May 8, physician groups urged Congress to work with CMS to improve the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) by establishing new performance measures and providing greater financial incentives for participating providers.
CMS released the fiscal year 2020 IPPS proposed rule in April, which addressed various requests for MS-DRG designations, and in particular, the request for a new MS-DRG designation for chimeric antigen receptor T-cell (CAR-T) therapies that CMS subsequently denied.
CMS’ recently released fiscal year (FY) 2020 Inpatient Prospective Payment System (IPPS) proposed rule includes 273 proposed ICD-10-CM code additions mainly affecting reporting for legal interventions, orbital roof fractures, and pressure-induced deep tissue damage. The code changes, if finalized, will take effect October 1, 2019.
CMS released the fiscal year (FY) 2020 IPPS proposed rule Tuesday, April 23, which included the annual ICD-10-CM/PCS code update proposals, significant changes to CC/MCC and MS-DRG designations, and a proposed increase to hospital payment rates.
Hospital/physician practice integration has contributed to an increase in chemotherapy drug treatment and injection administration spending under Medicare, according to a study recently published in Health Economics.
Researchers analyzed reports and clinical data from a community hospital for malnourished patients and concluded that of the 1,817 records for malnourished adult patients examined, 1,171 (64.4%) of them were not coded for malnutrition, according to the study published in the Journal of the Academy of Nutrition and Dietetics.
Members of the Medicare Payment Advisory Commission (MedPAC) asked the U.S. Department of Health and Human Services to create national coding guidelines for ED visits by 2022, following an April 4 meeting.
Sepsis is a leading cause of death in U.S. hospitals, but in most of cases, sepsis alone may not be the true cause of the majority of inpatient, septic hospital deaths, according to recent research published by the Journal of the American Medical Association.
CMS introduced seven new HCPCS codes and granted pass-through payment status to four separately payable drugs and biologicals in the April 2019 OPPS quarterly update.
During CMS’ two-day Coordination and Maintenance Committee meeting March 5 and 6, various stakeholders presented ICD-10-PCS proposals for consideration for future ICD-10-PCS code updates.
The second day of the ICD-10 Coordination and Maintenance Committee meeting, led by CMS and the Centers for Disease Control and Prevention’s National Center for Health Statistics, on March 5-6 focused largely on proposed ICD-10-CM code changes for mental health and musculoskeletal conditions.
A recent study showed that CMS’ Hospital Readmissions Reduction Program (HRRP) may be causing an increase in the 30-day mortality rate for certain conditions. Now, a second study published by Health Affairs claims that the reductions in readmission rates are themselves “illusory or overstated.”
CMS recently released Transmittal 4246 , revising language in Chapter 13 of the Medicare Claims Processing Manual regarding the billing of E/M codes on the same date of service as superficial radiation treatment delivery.
CMS recently released an MLN Matters article to inform hospitals and Medicare Administrator Contractors of new system changes, effective July 1, that ensure organ acquisition costs are not included in the IPPS payment calculation for claims that group to a non-transplant MS-DRG.
The American Hospital Association (AHA) and the U.S. Department of Health and Human Services (HHS) recently issued court-ordered briefs in which each defends its respective position in a federal 340B payment lawsuit. The case was brought against HHS by multiple hospital groups to reverse Medicare payment cuts for drugs purchased through CMS' 340B drug discount program.
Using financial penalties to reduce hospital readmissions has been linked to a significant rise in post-discharge mortality for patients with heart failure and pneumonia, according to a recent study by the Journal of the American Medical Association.
A recent study conducted by physician researchers at Stanford University highlights the challenges of CPT code-based patient classification and subsequent outcome analysis for colorectal procedures.
Average hospital costs and mortality rates are significantly higher for patients diagnosed with sepsis after hospital admission when compared with patients diagnosed prior to admission, according to a retrospective analysis recently published in Critical Care Medicine.
Findings show that pathologist involvement in the review and verification of CPT codes may reduce the need for code modifications at the time of sign-out auditing, according to the recent study published in the Archives of Pathology and Laboratory Medicine.
The Office of Inspector General (OIG) has been conducting a series of studies about adverse events in various healthcare settings since 2008 and will be publishing more of its corresponding reports throughout 2019, the OIG said in a statement.
A preliminary study found that a new point-of-care troponin assay safely ruled out acute myocardial infarction (AMI) in a large proportion of patients with symptoms suggestive of acute coronary syndrome, according to the report published in the Journal of the American Medical Association.
Findings from a retrospective cohort study published in the American Journal of Emergency Medicine suggest that, on average, EDs may report higher-level E/M services for incarcerated individuals when compared to the general population.
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.
