Kidney disease is a challenging component to inpatient and outpatient care, incurring significant costs and negative outcomes. CMS and other agencies that measure our quality and cost efficiency use ICD-10-CM codes based on provider documentation and billing to ascertain that a patient has a designated kidney anatomic or functional illness in their risk-adjustment methodologies.
When it comes to dealing with Medicare Recovery Auditors (RACs), there is never a dull moment for HIM professionals. Any shift in the RAC program quickly emerges as front-page news for HIM leaders.
Reimbursement for provider-based departments (PBD) can be complex, and regulations affecting it have changed frequently over the past year. Section 603 of the Bipartisan Budget Act of 2015, the 2017 outpatient prospective payment system (OPPS) final rule, and the 21st Century Cures Act changed the payment methodology and made multiple adjustments to the definition of excepted (on-campus or grandfathered off-campus) and non-excepted (off-campus) PBDs. Hospitals must know the regulations inside and out and understand how they apply to their PBDs and to avoid denials or noncompliance.
Regulatory compliance reforms have forced CMS to set the bar high for meeting evaluation and management (E/M) standards. This is especially true for clinical documentation improvement (CDI) performance for coding and billing level four and five patient visits in outpatient settings.
Overcoming barriers to care for LGBT individuals can require a culture shift at an organization, but it can be as simple as adding additional options to forms. It’s up to organizations to close the gap, and HIM plays a central role in identifying barriers, implementing change, and fostering a culturally competent environment.
The 2017 calendar year marks the beginning of a new approach to physician payment through the Quality Payment Program (QPP), an initiative created by the Medicare Access and CHIP Reauthorization Act to revise the physician payment system previously updated through the Sustainable Growth Rate.
Radiation oncology services billed to CMS had a 9.6% improper payment rate in 2015, leading to Medicare improperly paying $137 million for these services, according to a study reported in the Medicare Quarterly Compliance Newsletter.
