Coders prepared for 2017 with numerous changes to the Official Coding Guidelines for the ICD-10-CM and the addition of many new codes. Quietly waiting in the wings was the updated CPT® Manual for 2017 with its changes waiting to be discovered.
Where can we find the new Medicare Physician Fee Schedule (MPFS) rate for outpatient prospective payment system (OPPS), non-excepted departments? It didn’t seem to be clearly located on the MPFS final rule relative value units (RVU) file. Are we supposed to assume an exact 50% reduction of the OPPS rate?
Accurate clinical documentation is the bedrock of the legal medical record, billing, and coding. It is also the most complex and vulnerable part of revenue cycle because independent providers must document according to intricate and sometimes vague rules.
In a provider-based department, when an injection is provided by a registered nurse, is the admin fee billed on the hospital’s UB claim form with the drug or under global billed on the 1500?
How we define, diagnose, and document diagnoses that predict morbidity and mortality is essential if we want our patient’s risk to be accurately portrayed.
In several recent reports, the Office of Inspector General (OIG) determined that providers are, on average, variant from expected volumes on both short stay inpatient and long stay observation cases. What was not made clear in the OIG report is the reason why it believes such variances exist. The answer to this question likely rests within the details of how hospitals have adjusted (or not adjusted) to the use and application of “new criteria” in their daily and ongoing Medicare billing compliance processes.
As OPPS packaging has increased, providers may be less likely to appeal claims for certain denied charges based on medically unlikely edits, since it would not increase payments. However, providers should consider appeals when services are medically necessary and appropriate, as CMS bases future payment rates on accepted claims.
This week’s Medicare updates include a revision to State Operations Manual Appendix PP; ICD-10 Coding Revisions to NCDs, clarification of payment policy changes for Negative Pressure Wound Therapy using a disposable device and the outlier payment methodology for home health services; and more!
