An Office of Inspector General (OIG) audit of the University of Michigan Health System revealed noncompliance with four types of inpatient claims, including those associated with the billing of high-severity-level MS-DRGs.
CMS released Transmittal 3997 March 8, outlining HCPCS drug and biological code updates. These changes include updates to specific biosimilar biological product HCPCS codes, modifiers used with these biosimilar biologic products, and an autologous cellular immunotherapy treatment.
The cost for a hospital stay in 2014 involving acute renal failure (ARF) averaged $19,200, nearly twice the $9,900 average cost for stays not involving renal failure, according to the statistical brief published by The Healthcare Cost and Utilization Project (HCUP).
The World Health Organization is preparing for the official release of the 11th Revision of the International Classification of Diseases, or ICD-11, in June.
Hospitals reduced central line-associated bloodstream infections (CLABSI) by 50% between 2008 and 2016, according to a new report released by the Centers for Disease Control and Prevention (CDC).
CMS released Transmittal 3950 on January 12 describing updates to a list of the HCPCS codes for Durable Medical Equipment Medicare Administrative Contractors and Part B Medicare Administrative Contractor jurisdictions.
Only 12% of eligible hospitals signed up for CMS’ Bundled Payments for Care Improvement Model 2 initiative and 47% of them dropped out completely within two years, according to a recent study by the Journal of the American Medical Association .
Medicare fee-for-service claims had a 90.5% accuracy rate and a 9.5% improper payment rate for all claims submitted between July 1, 2015- June 30, 2016, according to a recent CMS Comprehensive Error Rate Testing report.
On January 9, CMS announced the launch of Bundled Payments for Care Improvement Advanced from the agency’s Center for Medicare and Medicaid Innovation.
With providers continuing to expand clinical documentation improvement efforts into outpatient settings, ACDIS has published a position paper offering guidance to outpatient CDI departments for performing queries.
A report released by the American Hospital Association and Manatt Health found that facilities spend approximately $39 million annually to comply with 629 requirements across nine regulatory domains.
Upon reviewing 2,145 inpatient claims at 25 providers, the Office of Inspector General (OIG) found that all but one claim incorrectly included the ICD-9-CM diagnosis code for kwashiorkor (260). This resulted in overpayments in excess of $6 million, according to the OIG report .
Recent findings support the possibility that the Hospital Readmissions Reduction Program has had the unintended consequence of increased mortality in patients hospitalized with heart failure, says a study published by JAMA .
Providers will no longer be required to append modifier -GT (via interactive audio and video) to professional telehealth claims, effective January 1, 2018, according to a policy CMS finalized in the 2018 Medicare Physician Fee Schedule (MPFS) final rule.
While the 2018 OPPS final rule may be controversial for its payment cuts to drugs purchased through the 340B drug discount program, it contains several provisions supported by hospitals and other stakeholders.
Within the span of two days last week, CMS released final rules for three comprehensive policies, which have important financial implications for hospitals, physicians, and medical professionals in 2018.
Inpatient stays involving any opioid-related diagnosis increased by 14.1% after ICD-10-CM was implemented in 2015, according to a study recently published in Medical Care .
A Comprehensive Error Rate Testing (CERT) study showed insufficient documentation causes most improper payments for arthroscopic rotator cuff repairs, according to the October 2017 Medicare Quarterly Compliance Newsletter .
On October 4, CMS issued a notice in the Federal Register containing numerous corrections to the 2018 IPPS final rule, including significant recalculations of MS-DRG relative weights and all budget neutrality factors.
The October 2017 OPPS quarterly update introduced 12 new proprietary laboratory analysis CPT codes as well as a new modifier for a biosimilar biological product.
While the Affordable Care Act has led to fewer 30-day readmissions, this reduction in readmissions does not correlate with 30-day mortality rates, according to a recent JAMA study.
As part of the October 2017 OPPS update, CMS will revise its policy on upper eyelid blepharoplasty and blepharoptosis repairs to allow physicians to receive payment for medically necessary blepharoptosis repairs when performed with cosmetic blepharoplasty.
The Centers for Disease Control and Prevention (CDC), one of the Cooperating Parties responsible for the ICD-10-CM codes and guidelines, recently released a 2018 ICD-10-CM Official Guidelines for Coding and Reporting errata. Slight changes were made to the guidelines for diabetes, hypertension, and principal diagnosis selection.
The 2018 updates to the CPT Manual released in early September feature a total of 314 code changes. New codes for E/M visits, genetic testing services, and endovascular repairs of aortic aneurysms are among the 172 additions.
The fiscal year 2018 IPPS final rule included updates to payment rates and quality initiatives, as well as an ample amount of code changes and updates to ICD-10-PCS non-OR to OR code designations.
Don’t automatically presume a link between two conditions within a combination code in cases when a guideline requires that link to be explicitly documented, the latest version of the ICD-10-CM coding guidelines clarify.
One of the most controversial changes to the 2017 ICD-10-CM guidelines was the contradictory guidance for the term “with,” and that issue is addressed in the 2018 version of the guidelines.
On Wednesday, August 2, CMS released the fiscal year 2018 IPPS final rule which featured updates to various quality initiatives, along with annual payment updates for inpatient services.
The 2018 OPPS proposed rule included potential changes to certain radiology modifiers used by CMS to identify services for data collection as well as reimbursement.
According to a study published in Annals of Emergency Medicine, researchers studying emergency department (ED) visits found that electronic sepsis alert implementation increased ED sepsis detection from 83% to 96%.
The 2018 OPPS and Medicare Physician Fee Schedule proposed rules usually make their debuts around the Fourth of July, but despite a later release this year, there were plenty of fireworks within each rule that should generate provider feedback during the comment periods.
In June, CMS released the 2018 ICD-10-PCS Official Guidelines for Coding and Reporting which include various revisions from the 2017 guidelines. These changes come on the heels of the 2018 IPPS proposed rule and recently released ICD-10-PCS codes.
On June 13, CMS released the final 2018 ICD-10-PCS codes that will become effective October 1. These changes come on the heels of April’s IPPS proposed rule.
CMS released the final 2018 ICD-10-CM codes on its website on June 13, and the release contained more code changes than expected following a preview of the new code set in April’s 2018 IPPS proposed rule.
A recent study piloted by CHEST Journal found that surveillance-based clinical data, such as electronic health records, offered more reliable estimates of septic shock trends than coded records.
CMS released a change request May 30 describing modifications which will be implemented in the July 2017 quarterly update to the OPPS. These changes include new ophthalmologic and maternal care codes as well as a handful of new drug codes.
CMS issued a change request to provide guidance to Medicare Administrative Contractors on the use of a new modifier to append to claims for dialysis treatments for end-stage renal disease exceeding the 13 or 14 monthly allowable treatments.
On April 14, CMS released the fiscal year 2018 IPPS proposed rule, which included a proposal for the discontinuation of the CardioMEMS heart failure monitoring system add-on payment.
CMS released a change request April 28 which provides guidance for Medicare Administrative Contractors on how to ensure accurate program payment for moderate sedation services provided as part of screening colonoscopies.
CMS released four new resources in early April on the Merit-based Incentive Payment System, one of two new payment options under the Quality Payment Program initiative created by the Medicare Access and CHIP Reauthorization Act.
On Friday, April 14, CMS released the fiscal year 2018 IPPS proposed rule with updates to quality initiatives and 2018 ICD-10-PCS and ICD-10-CM code proposals.
Audited hospitals generally applied modifier -59 (distinct procedural service) incorrectly when billing for outpatient right heart catheterizations and heart biopsies provided during the same encounter, leading to overpayments totaling approximately $7.6 million, according to a March report from the Office of Inspector General.
Written comments on upcoming ICD-10-CM/PCS code changes presented during the ICD-10 Coordination and Maintenance Committee meeting in March are due Friday, April 7.
CMS released a new educational initiative , Connected Care , on March 15 to help raise awareness of the benefits of chronic care management services, as Medicare has recently added and started paying for these services.
On March 8, CMS released eight frequently asked questions (FAQ) related to the Medicare Outpatient Observation Notice (MOON). The FAQs reinforce that psychiatric hospitals must comply with the Notice of Observation Treatment and Implication for Care Eligibility Act and MOON.
A study conducted by Journal of American Medical Association (JAMA) based on data obtained from the 2013 Nationwide Readmissions Database, revealed that sepsis accounts for a higher rate of unplanned readmissions than the other studied medical conditions.
The ICD-10 Coordination and Maintenance Committee will meet March 7-8 to discuss new conditions, procedures, and expanded details that could appear in a future update of the code set.
