In the transition to value-based care and pay-for-performance reimbursements, more providers are shifting care to outpatient settings. However, few HIM departments are prepared to optimize outpatient documentation and coding , which hinders the financial returns from this rapidly growing segment...
Commercial and government payers track chronic conditions using Hierarchical Condition Category (HCC), and providers can track HCCs to better monitor and project reimbursement and compliance.
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’ fiscal year (FY) 2020 Inpatient Prospective Payment System (IPPS) proposed rule, released April 23, includes a proposed increase to hospital payment rates, annual ICD-10-CM/PCS code update proposals, and significant changes to complication or comorbidity (CC)/major complication or comorbidity (MCC) and Medicare-Severity Diagnosis-Related Group (MS-DRG) designations.
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.
Representatives from CMS and the Office of Inspector General (OIG) discussed hot topics and focus areas at HCCA's 2019 Compliance Institute in Boston, including developing interactive documentation checklists, potential changes to Stark Law this year, and methods to address the high rate of coding and documentation errors on inpatient rehabilitiation facility (IRF) claims.
CMS finalized changes to NCCI Medically Unlikely Edits (MUE) and procedure-to-procedure (PTP) edits in its quarterly update to NCCI edit files, effective April 1.
