Q: I was on a conference call with the CDM coordinators within my health system and we got involved in a lively discussion. If there's no medical necessity for observation, what do you do with charges? Our departments get productivity based on the charges posted. We all agreed that the observation charges shouldn't be billed to the insurance but had different opinions on how it should be handled.
CMS published the FY 2020 Inpatient Prospective Payment System (IPPS) proposed rule on April 23, introducing policies designed to significantly alter rural health payments and expedite opportunities to pay for new technology.
The April 2019 OPPS quarterly update reassigned specific skin substitute products from the low-cost group to the high-cost group, and clarified billing and reporting for chimeric antigen receptor T-cell (CAR-T) therapy procedures performed in the outpatient setting.
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.
The improper payment rate for routine venipuncture lab tests was 16.3% in 2018, representing more than $20 million, and medical necessity errors accounted 98.9% of the improper payments, according to CMS.
