CMS recently announced a delay in the anticipated system release of outpatient and inpatient quality reporting data due to the relocation of the Health Care Quality Information System Data Center responsible for the Hospital Quality Reporting programs.
CMS is reporting that the Quality Improvement and Evaluation System (QIES) will be down for five days in March due to extended systems maintenance. The QIES will be unavailable starting at 8 p.m. Eastern on March 16, and returning March 21 at 11:59 p.m., according to CMS.
As the healthcare industry acclimates to using ICD-10, coders can rest assured it will still be several years until ICD-11 becomes a reality. Originally pegged for a 2015 release to the World Health Assembly, the World Health Organization (WHO) has quietly pushed ICD-11’s debut to 2018.
A decrease in staff productivity has been the top challenge for providers after ICD-10 was implemented, but relatively few organizations have seen a significant decrease, according to a recent survey from Navicure.
The improper payment rate for oxygen equipment and supplies to the Medicare program was 62.1% with projected improper payments of approximately $952 million during the 2014 reporting period, according to a Comprehensive Error Rate Testing (CERT) program study detailed in the January 2016 issue of the Medicare Quarterly Compliance Newsletter.
If two ICD-10-CM diagnoses are not related to each other, but exist at the same time, they may be reported together despite an Excludes1 note, according to a recent release from the Centers for Disease Control and Prevention. The coding advice has been approved by the four Cooperating Parties—the American Health Information Management Association, the American Hospital Association, CMS, and the National Center for Health Statistics.
While providers are still awaiting further guidance on the four modifiers CMS introduced as subsets of modifier -59 (distinct procedural service), the latest NCCI Manual does include clarification for certain scenarios involving the modifier.
Outpatient coding and billing errors lead to more than half of all automated denials by Recovery Auditors, according to the latest RACTrac survey from the American Hospital Association.
A recent court ruling determined that CMS had to explain its calculation for a negative 0.2% reduction in inpatient payment rates as a result of implementing the 2-midnight rule. The court also said that providers should have an opportunity to comment on the calculation.
CMS recently released an ICD-10-CM resource for specialties and specific conditions and services that collects varied educational tools, including webcasts, case studies, and clinical concept guides.
ICD-10 implementation has gone smoothly for approximately 80% of attendees who responded to a survey during a recent webcast from audit, tax, and advisory firm KPMG.
CMS and Medicare Administrative Contractors are aware of certain issues regarding National Coverage Determinations and Local Coverage Determinations related to ICD-10 and working to resolve them as soon as possible, according to CMS.
Jugna Shah, MPH, and Valerie A. Rinkle, MPA, review newpolicies and regulations from CMS in the 2016 OPPS final rule, including a new comprehensive APC for observation.
CMS does not require ordering providers to rewrite orders prior to ICD-10 implementation with appropriate diagnosis codes for laboratory, radiology, and other services, including durable medical equipment, prosthetics, orthotics, and supplies, according to a new FAQ.
CMS introduced several new HCPCS codes and added comprehensive APCs (C-APC), including one for observation, in the 2016 OPPS final rule, released October 30.
CMS finalized its proposals regarding the 2-midnight rule in the 2016 OPPS final rule, including moving responsibility for enforcement and education of the rule from Recovery Auditors to Quality Improvement Organizations (QIO). This latter change occurred October 1, 2015.
Insufficient documentation is the leading cause of improper payments for claims involving referring providers, according to a Comprehensive Error Rate Testing (CERT) program study detailed in the October 2015 Medicare Quarterly Compliance Newsletter .
CMS released a new resource to help providers find the right contacts for ICD-10 questions involving Medicare and Medicaid claims. The resource guide and contact list provides phone numbers or email addresses for Medicare Administrative Contractors and state Medicaid offices for each state and U.S. territory.
Recovery Auditors have identified numerous potential duplicate claims from Medicare Part B providers, according to the October 2015 Medicare Quarterly Compliance Newsletter . These claims are send to MACs for further action, which could include overpayment recovery.
