Ask the Expert

Q: You previously talked about drugs with pass-through status beginning in April, but are there any other items with changes in the OPPS update? 

Q: What should the utilization review committee look for when an inpatient stay is less than two midnights?

Q: What should case managers do when a patient lacks decision-making capacity but has no guardian or power of attorney?

Q: Our pharmacy is asking if there is going to be payment for a new anti-hemophilia factor called Nuwiq. They say it is quite expensive and they want to know if there is additional payment for it.

Q: What elements must be included for inpatient certification?

Q: What are some questions case managers can ask during the screening process?

Q: We have started using what our physicians call “high-frequency” neurostimulators. I know there are two HCPCS codes for reporting these to Medicare, but how do we know what is high frequency and what is not?

Q: How are covered observation services paid?

Q: Which hospital patients must be screened an assessed for a discharge plan?

Q: Did CMS ever add the drug screening HCPCS codes to the system so we can process these claims?