Mastering hierarchical condition categories (HCC) is key to success under new reimbursement methodologies that rely on risk-adjustment, quality, and value metrics such as the Quality Payment Program (QPP). Organizations need to take a close look at their training and audit programs to ensure that valuable information isn’t being left out of documentation—and negatively impacting HCC scores.
Physician specialist payments could vary as much as 29% by 2020 under the Merit-Based Incentive Payment System (MIPS), according to the October 5 press release by Avalere. This is due to CMS’s proposal to include Medicare payments for Part B drugs in the calculation of the MIPS payment adjustment.
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 Centers for Disease Control and Prevention (CDC), one of the Cooperating Parties responsible for the ICD-10-CM codes and guidelines, recently released a 2018 ICD-10-CM Official Guidelines for Coding and Reporting errata. Slight changes were made to the guidelines for diabetes, hypertension, and principal diagnosis selection.
On October 4, CMS issued a notice in the Federal Register containing numerous corrections to the 2018 IPPS final rule, including significant recalculations of MS-DRG relative weights and all budget neutrality factors.
The new ICD-10-CM codes for FY 2018, effective October 1, represent significant changes in our documentation and coding practices. Let’s discuss some of these new codes and their potential impact upon your diagnostic decision-making and documentation.
In a rare bipartisan effort from Congress, 228 members of the House of Representatives urged CMS to abandon a proposal from the 2018 OPPS proposed rule which would drastically cut payments for hospitals participating in the 340B drug discount program.
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.
