Billing and reimbursement

Despite the 75 million consumers enrolled in high deductible health plans, many are still uncertain about their payment responsibility. 

The new ICD-10-CM codes for FY 2018, effective October 1, 2017, represent significant changes in some of our documentation and coding practices. Review the changes to the FY 2018 ICD-10-CM Official Guidelines for Coding and Reporting (the Guidelines), which must be embraced if our documentation, coding, and billing is to withstand compliance scrutiny from outside auditors and accountability agents.

Managing and maintaining the chargemaster requires sound, tested strategies and tactics.

A successful outpatient CDI program will be invaluable to an organization, but without a focus and plan the program can become overwhelmed and ineffective. HIM and CDI need to work closely together to identify the greatest areas of opportunity in the outpatient setting and ensure that goals are aligned throughout the continuum of care.

A number of providers feel unfamiliar with the impact of MACRA and whether they are eligible for participation in the program.

How should diagnostic services be covered in hospital outpatient departments?

The CMS policy in the 2018 OPPS proposed rule with potentially the largest administrative and financial burden for hospitals should not be finalized, according to the agency’s own advisory panel.

You may find significant changes to E/M reporting in the near future, including a pivot away from two key elements — history and physical exam — that largely determine a given level of service for your most common patient encounters.

While the American Medical Association supports some of CMS’ proposals for year two of the Medicare Quality Payment Program, it is advising CMS to do more to simplify value-based payments.

What sort of clinical integration does CMS expect between provider-based departments and hospitals?