CMS modified its proposal to expand prior authorization and step therapy to protected classes of drugs for Part D and Medicare Advantage beneficiaries, according to a final rule released May 16.
U.S. District Judge Rudolph Contreras last week reaffirmed that the U.S. Department of Health and Human Services (HHS) exceeded its authority when it made 2018 payment cuts to outpatient hospitals for certain drugs purchased through the 340B drug pricing program, and extended the ruling to 2019 payment cuts.
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.
The Department of Health and Human Services (HHS) released a detailed overview on March 11 of its fiscal year 2020 budget, as HHS Secretary Alex Azar prepared for a gauntlet of hearings on Capitol Hill about the proposal.
The AMA’s CPT Editorial Panel approved sweeping changes to documentation and code selection guidelines for evaluation and management codes. If finalized, the changes will shift the way practices select codes for both office and facility visits as soon as January 2021.
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.
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.
A Comprehensive Error Rate Testing (CERT) study showed that insufficient documentation causes most improper payments for observation and inpatient care services, according to the January 2019 Medicare Quarterly Compliance Newsletter.
