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AHA Coding Clinic 1st Quarter 2018 – Key Highlights

Coding Clinic 1st Quarter 2018 (effective with discharges starting February 18) unsurprisingly did not include any significant changes since the previous Coding Clinic release was more extensive. It is a good sign that many of the controversial and pressing issues like COPD with pneumonia sequencing has been addressed and now...

Telehealth Services – Proactively Assess Your Risk

In a recent review of telehealth services, the Office of Inspector General (OIG) found approximately one-third (31/100) of the claims reviewed did not meet Medicare telehealth requirements.  Of the 31 cases, the majority were noncompliant because the patients received care in a location not considered “rural.”  Institutions/facilities that provide telehealth...

March Regulatory Updates

Review of Statistical Sampling Methods: Pursuant to the regular updates to the Office of Inspector General Work Plan, the Centers for Medicare & Medicaid Services (CMS) is assessing statistical sampling methods used within the Medicare fee-for-service administrative appeal process.  Specifically, CMS is reviewing if the Medicare Administrative Contractors and Qualified...

Is Your Organization a Potential Target for OIG Compliance Review?

As part of a series of hospital compliance reviews, the Office of Inspector General (“OIG”) identifies target hospitals, reviews a probe sample of cases in identified risk areas and determines compliance with Medicare billing requirements. Recent results? Two major hospital systems being asked to pay back large sums of money...

MACRA Data Blocking Update

As healthcare organizations determine how to report under MIPS, consider recent guidance from the Centers for Medicare & Medicaid Services (“CMS”) on the data blocking provision. Eligible clinicians must show they are meeting the information blocking requirements by attesting to three statements about how they implement and use certified EHR...

2018 OPPS Key Highlights

How does the recently issued 2018 Medicare Physician Fee Schedule impact your organization? Get to know the following key provisions: Payment Rate Changes. Off-Campus Provider-Based Departments: Except for dedicated emergency department services, services furnished in off-campus provider-based departments that began billing under OPPS on or after November 2, 2015, or...

AHA Coding Clinic 4th Quarter 2017 – Key Highlights

Coding Clinic 4th Quarter 2017 (effective with discharges starting October 1st) included the FY 2018 ICD-10-CM/PCS codeset updates (see article here), Official Guideline revisions, and question and answer coding guidance. Below are the key highlights: Severe Sepsis Coding Guideline Change  Physicians must document the relationship between sepsis and organ dysfunction...

Assessing the Discharge Planning Process – Essential for Compliance and Reimbursement

Does your facility accept Medicare and Medicaid? For the majority of hospitals across the country, the answer is “yes”, requiring compliance with Medicare Conditions of Participation (CoP) for discharge planning. Discharge planning is not a new concept to hospitals, but recently, more detailed guidance combined with financial penalties associated with...

2018 ICD-10-CM and ICD-10-PCS Codeset Update – Key Highlights

The FY 2018 ICD-10-CM and PCS annual codeset update goes into effect October 1, 2017. Below are the key changes: Summary of Changes Codes ICD-10-CM ICD-10-PCS New 360 3,562 Revised 250+ 1,821 Deleted 142 646 ICD-10-CM New Acute Myocardial Infarction Codes I21.9 MCC Acute myocardial infarction, unspecified I21.A MCC Other...

Fraud Detection – CMS Changes Direction

Recently, the Centers for Medicare & Medicaid Services (“CMS”) released a process change in its fraud detection program shifting focus to providers who have the highest claim error rates or billing practices that vary significantly from their peers. In the past, CMS contractors selected providers using a more random approach...

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