Category: Blog

hospitals-face-medicare-payment-cuts

Hospitals Face Medicare Payment Cuts

Low-performing hospitals to see a 1 percent cut in Medicare payments under HAC Reduction Program in 2022. The Centers for Medicare & Medicaid Services (CMS) announced last month that 764 hospitals will face Medicare payment cuts in fiscal year (FY) 2022 under the Hospital-Acquired Condition Reduction Program (HACRP). The value-based program may reduce Medicare payments […]
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New Senate Bill Aims to Extend Medicare Telehealth Waivers By 2 Years

The bill proposes extending Medicare reimbursement for a range of telehealth services, including substance abuse treatment, for two years after the public health emergency has ended. A new piece of bipartisan legislation has been introduced in the US Senate that aims to extend access to telehealth for Medicare beneficiaries after the COVID-19 pandemic has ended. […]
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survey-finds-just-14-hospitals-are-compliant-price-transparency

Survey finds just 14% of hospitals are compliant with price transparency

The biggest noncompliance was non-posting or incomplete posting of all of the negotiated prices for each item and service. In a federal price transparency rule that took effect January 1, 2021, hospitals were tasked with posting all of their prices online in clear, easily accessible formats. But a new survey from patientrightsadvocate.org has found that, […]
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telehealth-ehr-use-increases-false-claims-act-violations-fraud

Telehealth, EHR Use Increases False Claims Act Violations, Fraud

As more providers leverage telehealth services and EHR systems, the federal government has seen increased False Claims Act violations and healthcare fraud. Healthcare digitization, including increased use of telehealth and EHR has led to a higher volume of healthcare fraud and False Claims Act (FCA) cases, according to lawyers from Hogan Lovells. The False Claims […]
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exploring-the-2022-updates-to-the-hospital-outpatient-quality-reporting-program

Exploring the 2022 Updates to the Hospital Outpatient Quality Reporting Program

  Coding professionals should familiarize themselves with three new measures in particular. In 2009, the Centers for Medicare & Medicaid Services (CMS) implemented a quality data reporting program for hospital outpatient services. The Hospital Outpatient Quality Reporting Program (Hospital OQR) is a pay-for-quality data reporting program mandated by the Tax Relief and Health Care Act […]
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Selecting the Principal Diagnosis Lies at the Heart of Inpatient Coding

The heart of the principal diagnosis selection is pivotal to accuracy and compliance. Since February is known as “National Heart Month,” a discussion on the heart of inpatient coding is appropriate, that being the “principal diagnosis.” When learning inpatient coding, a large amount of time is spent on understanding the guidelines, conventions, and application of […]
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Append Modifier FT for Unrelated Critical Care Services

On Jan. 14, coders and billers gained insight into proper use of novel HCPCS Level II modifier FT Unrelated evaluation and management (e/m) visit during a postoperative period, or on the same day as a procedure or another e/m visit. (report when an e/m visit is furnished within the global period but is unrelated, or […]
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COVID-19 Monoclonal Antibody Billing Update

  Ever since a public health emergency (PHE) for COVID-19 was declared on Jan. 27, 2020, there has been several new HCPCS Level II codes created for monoclonal antibody (mAb) products and administration. As confusing as all these new codes and billing requirements have been, nothing has caused as much trouble as the latest change […]
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ama-updates-cpt-codes-for-pediatric-covid-19-vaccine

AMA Updates CPT Codes for Pediatric COVID-19 Vaccine

The organization released new CPT codes for Pfizer’s pediatric COVID-19 vaccine once FDA grants emergency use authorization for children between six months and five years of age. The American Medical Association (AMA) has updated the Current Procedural Terminology (CPT) code set to include a new code for administering pediatric doses of Pfizer’s COVID-19 vaccine in […]
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9 New Introduction Codes Added to ICD-10-PCS

  Effective April 1, 2022, hospitals will have nine new procedure codes to describe the introduction or infusion of therapeutics, including the additional COVID-19 vaccines recently authorized for emergency use by the Food and Drug Administration. April Update The Centers for Medicare & Medicaid Services first introduced seven new ICD-10-PCS codes for the second quarter […]
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