Q: I'm told, although I'm not convinced, that our payment for Keytruda is denied by Anthem when we use Z51.11 (encounter for antineoplastic chemotherapy) first followed by the code for cancer, i.e. C34.12 (malignant neoplasm of upper lobe, left bronchus or lung). I reviewed the coding guidelines...Read More »
Expanded price transparency requirements are set to become reality for hospitals effective January 1, 2021. On November 15, CMS released a final rule that pushed ahead with many of the requirements originally included in the 2020 OPPS proposed rule.Read More »
NAHRI is currently accepting applications for its board and committees. Taking an active role in NAHRI can set you on the path to shape the future of the revenue integrity profession as well as advance your career.
The Patient-Driven Payment Model (PDPM) has so many nuances that can impact reimbursement that it is near impossible for SNFs to consider and capitalize on them all. Check your processes and procedures to ensure you’re taking advantage of or protecting against the following aspects of PDPM. ...Read More »
CMS is accepting comments until November 29 on a proposal to collect acquisition cost data from hospitals participating in the 340B drug discount program.Read More »
CMS is moving forward with multiple policies—effectively based on reducing reimbursement to hospitals—that have been deemed unlawful in court, according to the 2020 OPPS final rule, released Friday, November 1.Read More »
Q: Our new EHR system was built using logic for therapy charging based on both the AMA and CMS eight-minute rules. Charges will generate differently based on the payer. How do others implement the eight-minute rules? How do you think using two charging methodologies in this world of price...Read More »
