The 2020 calendar year was certainly challenging for revenue integrity professionals, as the novel coronavirus (COVID-19) pandemic stressed the workforce, necessitated new working environments, and led to frequent regulatory updates. Through case studies, news, and analysis in the weekly Revenue Integrity Insider enewsletter and the quarterly NAHRI Journal, NAHRI worked to keep the revenue integrity community informed of all the changes. Let’s take a look back at NAHRI’s most-read stories from 2020.
Q. The IFC for MFN states on pp. 122–123, “Because Medicare allows the lesser of the applicable payment amount or the billed amount, MFN participants will have to ensure that they submit an appropriate billing amount (or charge) for the alternative add-on for the applicable quarter.” The OPPS is a prospective payment system and the lesser of provisions do not apply for that payment system. Can a hospital submit a token or small charge and receive the full add-on payment amount? Asking hospitals to bill approximately $150 for each dose of a drug will significantly increase charges and distort cost to charge ratios. Will CMS clarify this in the OPPS January 1, 2021, transmittal and/or final rule?
NAHRI’s Revenue Integrity Symposium is a fantastic way to network with and learn from revenue integrity professionals from across the country. But have you considered that RIS can also help hone your professional speaking skills? NAHRI is currently seeking healthcare professionals who are willing to throw their hat into the RIS ring and submit proposals for the 2021 symposium. We will gather October 19–20, 2021, in Kissimmee, Florida.
The 2021 Outpatient Prospective Payment System (OPPS) final rule, released December 2, moves ahead with most of the provisions of the proposed rule. This should come as a relief to hospitals required to implement most of its policies by January 1, 2021.
The 2021 Medicare Physician Fee Schedule (MPFS) final rule, released December 2, extends certain telehealth benefits but makes cuts to the Medicare conversion factor (CF) to offset evaluation and management (E/M) changes that would otherwise have resulted in significant reimbursement increases. Most provisions of the final rule are effective January 1, 2021.
United Healthcare (UHC) recently announced that it is delaying the implementation date of its unique laboratory code policy. The policy, which was originally set to go into effect January 1, 2021, will be delayed until January 1, 2022.
CMS announced on November 25 that it is building on the flexibilities granted by the Hospitals Without Walls program to launch the Acute Hospital Care at Home program. Under this program, eligible hospitals will be allowed to treat certain inpatients in the patient’s home.
The New COVID-19 Treatments Add-on Payment will allow additional Medicare payment for eligible hospital inpatient and outpatient cases that involve certain new products or treatments authorized or approved for COVID-19.
