In the 2019 OPPS final rule, released Friday, November 2, CMS implemented several site-neutral payment policies, though the agency did delay or shelve other proposals due to stakeholder feedback.
Q: How are you carving out other services from observation? Are you using a standard time or calculating based on the time off the nursing unit? What services are you carving out? Are you carving out services for other non-Medicare payers?
The high volume of successful appeals, particularly on the first level, raises concerns that Medicare Advantage Organizations were denying payment and authorization for services that should have been provided, the OIG said.
By Marilyn Hart Niedzwiecki, MBA, CPA, RN, CPC, COC, CIRCC
NAHRI’s Revenue Integrity Symposium (RIS) will take place this year October 16–17 at the Wigwam Resort in Litchfield, Arizona, outside Phoenix. I think the RIS is a great way to stay up to date on new rules and regulations. It also allows for great networking. We all have complex positions that are not easily learned, and it helps to discuss with other professionals.
The National Association of Healthcare Revenue Integrity’s (NAHRI) 2018 Revenue Integrity Symposium is a great opportunity to learn from and network with peers. There are many interesting and timely topics to be covered. I’m looking forward to many of my colleagues’ presentations and it’s difficult to single out just one; I’m also very excited about the sessions I’m participating in.
The session I’m most looking forward to presenting at NAHRI's 2018 Revenue Integrity Symposium is “Next Generation Technologies: Practical Guidance for Success” because I really want to help demystify what appears to be misinformation, miscommunication, and perhaps just an overall lack of understanding about how CMS’ formulas for outliers and NTAP work. I also want to help clarify how what providers report today impacts payment rates two years down the road.
