In May, we expect to see the release of the International Classification of Diseases, 11th Edition, for Mortality and Morbidity Statistics (ICD-11-MMS) by the World Health Organization. Work will then begin in the U.S. to adapt it for our clinical use as ICD-11-CM. Hopefully, with the benefit of foresight and lessons learned from the past, we will not reenact the pain we all had with the ICD-10-CM/PCS implementation.
If ICD-10-CM/PCS is used to its full potential, it will provide greater detail and a more accurate depiction of patient severity. This level of detail is expected to provide more information about the relationship between a provider’s performance and the patient’s condition.
CMS’ policy in the 2018 OPPS final rule to cut reimbursement for drugs purchased through the 340B drug discount program by nearly 30%, accounting for the decrease from average sales price plus 6% to minus 22.5%, is getting a lot of attention from the provider community—and with good reason.
The term and concept of revenue integrity began emerging early in the 21st Century. This emergence was partly in response to concerns that phrases such as maximizing and optimizing revenue might imply gaming or failure to comply with regulations, laws, and business ethics.
CMS published Special Edition MLN Matters 17033 on December 6 as a reminder that it will not pay acute care hospitals for outpatient services provided to beneficiaries who are covered under a Part A inpatient stay at a separate facility.
