Tag Archives | CMS

Final Fiscal Year 2018 Payment and Policy Changes for Medicare Inpatient Rehabilitation Facilities

Overview On July 31, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a final rule outlining fiscal year (FY) 2018 Medicare payment policies and rates for the Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) and the IRF Quality Reporting Program (IRF QRP). The FY 2018 final policies are summarized below. Updates to […]

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Final ICD-10-CM Codes for 2018 Contain a Few Surprises

The final codes include 322 more changes than what was proposed by CMS in April’s hospital IPPS rule. Starting Oct. 1, it will be possible to select a specific ICD-10-CM code when a patient is in remission from abuse of each of a variety of substances, including alcohol, opioids, cannabis and nicotine. Those nine new […]

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Medicare Compliance: The Basics for Injury Settlement Recipients

Medicare is a government-provided health insurance program designed to assist certain people with hospital care, medical costs, and other expenses. Qualifying beneficiaries are people who are 65 or older, those younger than age 65 with certain disabilities, and people of all ages with permanent kidney failure. How to keep medicare eligibility If you were injured […]

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OIG Investigates Payments for Ambulance Transports of SNF Patients

Medicare’s Office of Inspector General (OIG) has issued a sixteen-question survey to many ambulance service suppliers. The survey is focused on SNF patients, and specifically why the ambulance service has billed Medicare Part B for transports while patients were in a Part A stay. During Part A stays, the nursing home receives Medicare payments that […]

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Medicare Cardiac, Ortho Bundled Payments Delayed Until 2018

CMS pushed back the implementation of compulsory Medicare cardiac and orthopedic bundled payment models and the Cardiac Rehabilitation Incentive Payment program until 2018. CMS recently delayed the launch date of three mandatory Medicare cardiac and orthopedic bundled payment models and the Cardiac Rehabilitation Incentive Payment program from May 20, 2017, to Jan. 1, 2018. The […]

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It is Time to be Change-Hardy with the new IPPS Proposed Rules

Be adaptable and ready for change if you are responsible for payer reimbursements in your healthcare organization. The Centers for Medicare & Medicaid Services (CMS) has announced a large number of changes to diagnosis-related groups DRGs for 2018, along with changes in ICD-10-CM and PCS. Here is a quick summary of the changes: 264 MS-DRGs […]

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CMS Tackles Opioid Prescribing

The Centers for Medicare & Medicaid Services (CMS) intends to align its Medicare plans, including Part D prescription plans, with the Centers for Disease Control and Prevention (CDC) opioid prescribing guidelines. On January 5, 2017, the agency released a statement justifying this action. Because of  “the growing body of evidence on the risks of misuse […]

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CMS Exempts Two Thirds of Clinicians From MIPS

The Centers for Medicare & Medicaid Services (CMS) has exempted about two thirds of physicians and other clinicians who provide care to Medicare beneficiaries from the Merit-based Incentive Payment System (MIPS), a pay-for-performance scheme that will determine part of physicians’ Medicare payments, starting in 2019. A CMS spokesman told Medscape Medical News, “CMS mailed approximately […]

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CMS Told To Crack Down On Improper Medicaid Payments

The Centers for Medicare & Medicaid Services needs to step up its involvement in states’ Medicaid integrity programs in order to strengthen oversight and identify overpayments, according to a new federal watchdog report. CMS oversees how states run their Medicaid integrity programs and supports fraud-fighting efforts through reviews, training and hiring contractors to audit providers. […]

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CMS Updates ICD-10 Quality Measures, More from C&M Meeting

The Centers for Medicare and Medicaid Services (CMS) has released an update to the ICD-10 and Quality Measures website. The home page covers ambulatory surgical centers, hospital inpatient and outpatient, Centers for Disease Control (CDC) and National Healthcare Safety Network (NHSN) Surgical Site Infections (SSI) Measures, CMS outcome and payment measures, Agency for Healthcare and […]

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C&M Update: Enhancements to ICD-10 Continue

The ICD-10-CM/PCS Coordination and Maintenance (C&M) Committee met this past week, and there were lots of proposed enhancements to the code set presented and discussed. According to the Oxford dictionary, “enhancement” means an increase or improvement in quality, value, or extent. This definition truly describes the efforts of the C&M Committee and those who participate […]

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How to Take Advantage of New Coding Opportunities in 2017

A new year means new codes and new revenue opportunities for medical practices—but also new challenges to ensure the codes are used correctly. Below is a brief summary of new current procedural terminology (CPT) codes, modifiers and place of service codes that went into effect January 1, 2017. Add-on prolonged E/M services You’ll find a […]

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Everything Doctors Should Know About ICD-10 Glitch

CMS has announced a glitch in the quality reporting measures brought upon by the changes in the ICD-CM (Clinical Modification) and ICD-PCS (Procedural Coding System) updates that went into affect Oct. 1. While CMS is a bit unclear as to exactly what the problem is, there are a few things we know: This glitch only […]

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How to Successfully Communicate Your Clinical Validation Concerns

Five tactics to educate physicians and improve documentation. Q: Our coders and coding auditors often see patterns of incorrect physician documentation. Sometimes the error impacts the MS-DRG, but many times it does not. What recourse do we have to communicate our clinical validation concerns? A: Your situation is certainly not unique. In a world where […]

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ICD-10 Glitch Causes CMS To Relax Payment Penalties

Massive ICD-10 code update is responsible for clogging system and leading to reporting problems. ICD-10 has hit yet another snag after massive code updates resulted in a clogged system and reporting problems for the Physical Quality Reporting system. As a result, CMS has decided to waive the penalties for 2017 and 2018. All eligible professionals […]

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Transformation with Transplantation

Are you an organ donor? Before October 2005, I did not think much about this question. You may ask what happened in October 2005. My cousin had a heart transplant that month. He had been on the heart transplant list since October 1996. My cousin was 45 years old and suffered a heart attack when […]

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