Healthcare organizations and providers are experiencing a shift in outpatient reimbursement: from fee-for-service to Alternative Payment Models and value-based reimbursement based on quality outcomes. Coding errors, documentation gaps, claim denials, and accounts not billed due to claim edits are typically much higher on the outpatient side due to sheer volume.
Q: We are considering using of ICD-10 code Z79.899 (Other long term (current) drug therapy) to support medical necessity for lab testing while a patient is having chemotherapy. What is considered long term where this code is concerned?
The AMA’s CPT Editorial Panel approved sweeping changes to documentation and code selection guidelines for evaluation and management codes. If finalized, the changes will shift the way practices select codes for both office and facility visits as soon as January 2021.
Community Hospital in Munster, Indiana, is disputing an Office of Inspector General (OIG) report that found DRG assignment errors and incorrect inpatient rehabilitation facility (IRF) claims, resulting in an projected $22,051,602 in overpayments.
CMS is seeking comments on a proposed coverage with evidence development for chimeric antigen receptor T-cell (CAR-T) therapy for relapsed or refractory cancer when prescribed by the treating oncologist.
