A federal judge ruled in favor of the American Hospital Association (AHA) and other industry plaintiffs on September 28, ordering HHS to stop its reimbursement cuts to the 340B Drug Pricing Program for the remainder of the year.
The Office of Inspector General (OIG) recently released an audit report on Medicare integrity risks related to billing for telehealth services during the first year of the COVID-19 pandemic. Although the OIG identified only a small portion of high-risk providers, it acknowledged the need for additional oversight as telehealth continues to grow in popularity.
HHS recently released final rules for implementing components of the No Surprises Act. These rules expand upon several provisions of the July 2021 and October 2021 interim final rules regarding the qualified payment amount and the federal independent dispute resolution process.
Q: How do we to handle charges for donor-related services when the donor is an unsuccessful match? Should the charges for services provided to a potential donor who is an unsuccessful match also be included on the transplant recipient claim or should they be adjusted and just included on the cost report?
CMS is weighing an expansion of the hospital outpatient department prior authorization program, changes to 340B reimbursement in the wake of the Supreme Court’s decision, and alternative rate setting data among other proposals in the 2023 Outpatient Prospective Payment System (OPPS) proposed rule.
In the 2022 NAHRI Leadership Council survey: Custom Edits—Creation and Workflow, 100 leaders, including revenue integrity, health information management (HIM), and coding directors and managers primarily from acute care hospitals and health systems with 500+ beds shared key insights into their custom edit processes, including workflow locations, oversight hierarchy, and the leading factors that drive custom edits.