PLEURAL EFFUSION WITHOUT CC/MCC DRG Code 188

Warning: EMR templates may be your medical review downfall. If you think your agency’s claims will pass medical review with flying colors because you’ve nailed face-to-face encounter requirements, you may need to think again. Why? Another denial reason is giving [...]

LUPAs are way up, but the much-protested payment cut stays in proposed rule. After a punishing pandemic and often rocky start to the Patient-Driven Groupings Model, many home health agencies have been hoping for some relief on the payment cut [...]

Hospice horror stories may chill referrals. When mainstream press outlets like the Washington Post and CNN use “hospice” and “maggots” in the same headline, fallout for the hospice industry won’t be far behind. That’s what’s occurring in the wake of [...]

New PDGM is HHGM with a few tweaks. If you didn’t like Medicare’s ideas on home health payment reform last year, you’re probably not going to be happy with its newly proposed model either. Why? The Patient-Driven Groupings Model unveiled [...]

Note this big change to reporting drug costs. Newly released hospice cost report revisions may mean more work for you, but should result in more accurate data that will be used for rate-setting and other purposes in the future. In [...]

A claims processing error at one HHH Medicare Administrative Contractor may mean more work for you. Problem: CGS saw file rejections for the HICN number on Mon. July 3 through July 5, 2017, prior to 9 a.m. EST for Part [...]

A claims processing glitch at one HHH Medicare Administrative Contractor may mean more work for you. Problem: CGS saw file rejections for the HICN number on Mon. July 3 through July 5, 2017, prior to 9 a.m. EST for Part [...]

Proposed rule would allow patients to sue you under Section 1557. When Congress passed the Patient Protection and Affordable Care Act (ACA) in 2010, Section 1557 of the law provided a plethora of new protections for healthcare consumers, in particular [...]

These are the winners and losers under the Value-Based Purchasing proposal. Except for a few tweaks, the Value-Based Purchasing model proposed in the 2016 rule follows the outline Medicare set out in the 2015 rule. It will reward or penalize [...]

Check for procedure, medication, and diagnosis. Your medication administration coding accuracy depends on three key things: what your physician administered, through what route, and for how long. Getting those the three factors right every time can take practice. Test your [...]