Providers in some states may soon discover a big hurdle to clear when seeking to report a set of apheresis services after one MAC tightened up physician supervision requirements.
The Office of Inspector General found CMS improperly awarded an estimated $4.6 million in reimbursement for immunosuppressive drugs billed with modifier -KX (requirements specified in the medical policy have been met). The OIG also said CMS should revise guidance on modifier -KX because current guidance is confusing and contradictory.
CMS rescinded Transmittal SE1607 August 18, which was related to its enforcement of the 20 hours per week billing requirement for its partial hospitalization program.
As CMS and third-party payers have looked for ways to treat patients in the outpatient setting and reduce inpatient volumes, CMS has used the 2-midnight rule, in addition to other methods, to treat patients as outpatients or in observation whenever possible.
The Joint Commission continues to provide excellent resources to help healthcare organizations stay ready for surveys, as well as resources that help them meet and understand the intent of standards and elements of performance.
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.
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.
