Provider participation in the BPCI Advanced program fell by 16% between October 1, 2018, and March 1, 2019, at the initiation of the risk-bearing phase of the voluntary payment program. Overall participation includes nearly 1,300 providers still participating, according to CMS.
Representatives from CMS and the Office of Inspector General (OIG) discussed hot topics and focus areas at HCCA's 2019 Compliance Institute in Boston, including developing interactive documentation checklists, potential changes to Stark Law this year, and methods to address the high rate of coding and documentation errors on inpatient rehabilitiation facility (IRF) claims.
Providers will find significant leeway in how they can approach and report advance care planning services for physicians given CMS’ open-ended coding requirements, which should push the already strong growth of the codes to new heights.
CMS finalized changes to NCCI Medically Unlikely Edits (MUE) and procedure-to-procedure (PTP) edits in its quarterly update to NCCI edit files, effective April 1.
The Government Accountability Office (GAO) recommended that CMS assess and strengthen documentation requirements and medical reviews to more effectively prevent improper payments.
CMS announced that it will soon begin accepting applications to participate in its second cohort of the Bundled Payments for Care Improvement (BPCI) Advanced Model starting in January 2020.
MedStar Health, a Maryland-based health system, agreed to pay $35 million to settle allegations that it paid kickbacks to a cardiology group for referrals and that it received inappropriate Medicare payments for medically unnecessary cardiac stents.
The April 2019 OPPS quarterly update reassigned specific skin substitute products from the low-cost group to the high-cost group, and clarified billing and reporting for chimeric antigen receptor T-cell (CAR-T) therapy procedures performed in the outpatient setting.
