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.
CMS pushed the February 15 submission deadlines for select inpatient clinical and healthcare-associated infection measure data, citing system glitches and inaccessibility to QualityNet reports.
Radiation oncology services billed to CMS had a 9.6% improper payment rate in 2015, leading to Medicare improperly paying $137 million for these services, according to a study reported in the January 2016 Medicare Quarterly Compliance Newsletter .
In January, the Society of Critical Care Medicine and the European Society of Intensive Care Medicine released the 2016 Surviving Sepsis guidelines, adopting the new consensus definitions for sepsis and septic shock (Sepsis-3) established last year.
A Comprehensive Error Rate Testing study showed insufficient documentation caused most improper payments for facet joint injections, according to the January 2016 Medicare Quarterly Compliance Newsletter .
Hospital-acquired conditions (HAC) declined by 21% between 2010 and 2015, saving an estimated 125,000 lives and $28 billion in health care costs, according to preliminary results published by the Agency for Healthcare Research and Quality .
Insufficient documentation caused most improper payments for retinal photocoagulation payments reviewed in a Comprehensive Error Rate Testing study, according to the January 2016 Medicare Quarterly Compliance Newsletter.
A clinical documentation improvement (CDI) team can rapidly lead to quality improvements, according to a recent survey conducted by Black Book Market Research.
Late in 2016, CMS finalized three bundled payment models focusing on cardiac care and another for orthopedic care, while also updating aspects of the Comprehensive Care for Joint Replacement (CJR) Model introduced in April 2016.
CMS recently made an administrative settlement process available for inpatient status claims. This process is open to eligible hospitals willing to withdraw pending appeals in exchange for a timely partial payment, or 66% of the net allowable amount, CMS said in the statement.
After missing a proposed fall start date, CMS announced last week that its Medicare Part B drug payment model from the Center for Medicare and Medicaid Innovation will not be going forward.
Last week, CMS released an updated version of the Medicare Outpatient Observation Notice (MOON), which stated that effective March 8, 2017, hospitals will be required to present the MOON advisory in writing and verbally to Medicare beneficiaries who receive at least 24 hours of hospital services under outpatient status.
CMS made no changes for quality measures related to 2019 payment determinations that require reporting next year in the 2017 OPPS final rule. However, for payment determinations in 2020 and subsequent years, CMS is finalizing proposals on seven quality measures.
On October 31, CMS announced that it awarded contracts to the next round of Medicare fee-for-service Recovery Auditors. The base period for contracts is 12 months from the date the contract is awarded, said CMS.
CMS released the 2017 OPPS final rule November 1, implementing site-neutral payment policies required by Section 603 of the Bipartisan Budget Act, adding new comprehensive APCs, and refining several packaging policies.
According to the recent RACTrac survey released from the American Hospital Association, 60% of claims reviewed by Recovery Auditors in the second quarter of 2016 were found to not have an overpayment.
CMS released the final rule implementing provisions of the Medicare Access and CHIP Reauthorization Act of 2015 on October 14, giving providers a timeline and outline of the quality programs and payment models that will replace the Sustainable Growth Rate and other programs.
In early August, hospitals got a last-minute reprieve from the Medicare Outpatient Observation Notice (MOON) notification requirement. CMS detailed the need for additional time to revise the standardized notification form that hospitals will need to use to notify patients about the financial implications of being assigned to observation services; and, as of now, the requirement is still in delay.
More than half of the members of Congress have written to CMS to consider changes to its proposals for implementation of Section 603 of the Bipartisan Budget Act of 2015 regarding off-campus, provider-based departments.
