This week’s Medicare updates include corrections to the IPPS final rule; corrections to the Skilled Nursing Facilities Prospective Payment System final rule; year 3 baseline data on Medicare payments for clinical diagnostic laboratory tests; and more!
This week’s Medicare updates include clarification on portable x-ray necessity, recommendations from the hospital outpatient payment advisory panel, an adjustment to the amount in controversy threshold amounts for 2018, and more!
Root cause analysis of edits and an understanding of the relationship between the chargemaster and HIM/coding must be supported by overarching principles and best practices for edit management. Processes should be built around the timing of edits, applying edits across payers, and denial management.
The Office of Inspector General recently reviewed $51.6 million in Medicare Part B payments to acute care hospitals only to find that Medicare did not appropriately pay the hospitals for any of the reviewed outpatient services. In addition, beneficiaries were charged with $14.4 million in unnecessary deductibles and coinsurances for the hospital outpatient services.
