CMS Changes Effective April 4, 2014

Here are a few highlights of the changes effective April 2014.  New services have been released in attachment A and are assigned for payment under the Outpatient Perspective Payment System. Table 1: New services payable under OPPS Effective April 1, 2014 C9739 Cystrourethrsocopy, with insertion of transprostatic implant; 1-3 implants C9740 Cystrourethroscopy, with insertion of … [Read More]

RAC Hit’s Region C for Incorrect Billing of Hydration Therapy

Outpatient hospital services for hydration therapy have been approved for automated review. The issue for review is due to incorrect billing of hydration therapy with diagnosis codes that are not considered reasonable and medically necessary per the applicable Local Coverage Determination (LCD). Novitas Region C states will be affected. If your facility is in this … [Read More]

Risk Mitigation in Today’s Healthcare Environment

The Critical Role of Analytics in Managing the Strategic Decision Process By Jack Duffy Executive Vice President   We have all heard the expression “Betting the farm” – farmers understand that a poor decision on diversifying crop selection, planting dates, water and weather can determine the success and future of their farm. The significance of … [Read More]

The 2014 OIG Work Plan Has Arrived!

The Officer of Inspector General has finally released the 2014 work plan!  Some of the areas of interest for hospitals are as follows: Reconciliations of Outlier Payments In the area of Policies and Practices, the OIG will review the Medicare outlier payments to hospitals in order to determine whether CMS performed the necessary reconciliations in … [Read More]

Take Steps to Insure Two Midnight Rule Compliance

The two midnight rule affects both outpatient/observation and inpatient status. It is designed to limit the use of observation status for Medicare patients, which results in higher out-of-pocket costs for Medicare beneficiaries. The 2014 Inpatient Prospective Payment System (IPPS) final rule, published August 2, 2013, established new requirements for coverage of Medicare Part A inpatient … [Read More]

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