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’ 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.
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.
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.
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.
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.
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.
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.
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 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.
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.
CMS recently released both the calendar year (CY) 2019 Medicare Physician Fee Schedule and OPPS final rules last week, revising the payment structure for E/M office visits and expanding payment reductions for drugs purchased under the 340B discount pricing program by nonexcepted, off-campus, provider-based departments.
A retrospective study recently published in the Journal of Pediatric Surgery found that 59% of reviewed cases across four institutions contained discrepancies between operative dictation and CPT coding for pediatric abdominal surgeries.
The American Medical Association recently released the 2019 CPT code set, which includes 335 code changes, primarily for skin biopsies, fine needle aspirations, and central nervous system assessments. All changes take effect January 1.
CMS’ 2019 OPPS proposed rule continues the agency’s efforts to enforce site-neutral payments and reduce drug payments by introducing policies to reduce reimbursement for hospital outpatient clinic visits at off-campus, provider-based departments (PBD) and expanding last year’s payment reductions for drugs purchased under the 340B discount pricing program by nonexcepted PBDs.