Q&A: CMS makes annual updates for items with pass-through status
Q: Is CMS adding any items with pass-through status for 2016? We are starting to look at reimbursement under ICD-10 and wanted to be sure we included these items. A: According to the annual update...
View ArticleAdd this best practice to improve your results with patients
If you spend more time looking at charts than patients, you might be missing important opportunities to improve care and prevent readmissions. Face time with patients is critical, says Karen Zander,...
View ArticleQ&A: Requirements for reporting value code FD
Q: Are we still required to report value code FD (credit received from the manufacturer for a replaced medical device) in 2016? We are having an incredibly difficult time getting the information flow...
View ArticleAsk the expert: Is the three-day qualifying stay going away?
Under current Medicare rules, patients can only get coverage for a stay in a skilled nursing facility (SNF) if they’ve spent three consecutive inpatient days in a hospital. If they are receiving...
View ArticleAsk the expert: How can we ensure the right documentation for a level of care...
Many questions have swirled around the issue of medical necessity and how to document it appropriately. Stefani Daniels, RN, MSNA, CMAC, ACM, founder and managing partner of Phoenix Medical Management,...
View ArticleQ&A: How will CMS handle device edits related to procedures in 2016?
A: CMS is not going to resurrect or reinstate the device-to-procedure edits for all procedures that use a device. CMS notes in the 2016 OPPS final rule that it expects to see the appropriate and...
View ArticleCMS approves bundled payments for knee and hip replacement surgeries
On November 16, CMS released a final rule that bundles acute care payments for knee and hip replacement surgeries, the most common type of inpatient surgery for Medicare beneficiaries. Doctors...
View ArticleQuestions about knee and hip bundled payments
On November 16, CMS released a final rule that bundles acute care payments for knee and hip replacement surgeries, the most common type of inpatient surgery for Medicare beneficiaries. Doctors...
View ArticleQ&A: Prepare for requirements when reporting biosimilars
Q: Last week, you said there is a code for reporting the biosimilar for filgrastim. How is CMS going to pay for the drugs and are there any “surprises” that we should look out for? A: CMS has initiated...
View ArticleQIO audits reaching back farther than expected
Bad news if your organization is still a little shaky on 2-midnight rule compliance. Quality Improvement Organization (QIO) short-stay audits started October 1 and auditors are looking for records as...
View ArticleCare coordination is an international problem
In recent years, healthcare officials have been striving to improve care coordination, which can both improve quality and outcomes for patients and lower healthcare costs. Turns out the U.S. isn’t the...
View ArticleQ&A: Setting a price for corneal tissue
Q: I have a follow-up question to an answer you gave early last year. The question was about reimbursement for the cost of corneal tissue. You stated “This line item should reflect the costs associated...
View ArticleBridge the communication gap with physicians with these tips
Do you sometimes feel like you and the physicians at your hospital aren’t communicating as well as you could be? Even the best case managers can sometimes feel like a buzzing fly, annoying physicians...
View ArticleQ&A: Should we hardcode modifier ?CT?
Q: Our radiology department is requesting that we add a new modifier to their charge description master (CDM), modifier –CT (computed tomography [CT] services furnished using equipment that does not...
View ArticleDon't underestimate the importance of good documentation
It’s an unfortunate part of healthcare today—the lawsuit. Are you ready if one is filed against your organization? You are if your documentation is in order, says Peggy Rossi, BSN, MPA, CCM, a...
View ArticleQ&A: Submitting claims for observation services
Q: Did something change with the observation services Composite APC in 2016? The director of patient financial services says we no longer receive payment for it.A: The observation services Composite...
View ArticleTwo-Midnight Rule: Initial Reviews to Resume
Having taken time out for retraining and internal audits, contractors may resume initial-phase reviews of Medicare reimbursement claims for short-stay inpatient hospital care, CMS says.FULL STORY
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