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 again and that is our instruction. Does anyone have experience with this issue?
The purpose of this policy is to define routine daily hospital services, covered medical and surgical services and supplies, which are sometimes referred to as room and board. This policy is not intended to impact medical practice or care decisions.
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.
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.
CMS is accepting comments until November 29 on a proposal to collect acquisition cost data from hospitals participating in the 340B drug discount program.
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 transparency will look?
A federal judge rejected CMS’ motion to reconsider or issue a stay on her September order to vacate cuts to reimbursement to grandfathered off-campus provider-based departments.
Q: We are in the middle of changing the hospital methodology for charging cardiac cath procedures within Epic CUPID. What is your hospital’s workflow for charging cardiac cath procedures?
Take an in-depth look at the 2020 IPPS final rule to ensure your organization is ready for a major revision to the hospital wage index calculation and more.
