OCR settles a cornucopia of cases in mid-year sweep. The first half of 2023 was relatively quiet on the HIPAA enforcement front, with much of the feds’ focus on proposals, announcements, and guidance in the wake of the COVID-19 public [...]
Question: In what instances should I consider appending modifier 22 to surgical claims? California Subscriber Answer: A recent CPT® Assistant (Volume 30; Issue 5) does a good job at breaking down some of the rules and regulations surrounding modifier 22 (Increased procedural [...]
Question: I want to audit our new sleep behavioral psychologist charts. How different is auditing his charts from physician auditing? Where can I find guidelines for sleep behavioral therapy (90791, 90832, 90834 and 96101)? Michigan Subscriber Answer: Ignore the sleep part and [...]
HHA cuts will be closer to 4% next year, expert claims. When the PPS final rule comes out in a month or so, providers are hoping it won’t contain the devastating cuts contained in this summer’s proposal — but those [...]
Question: Has there been any update on Medicare’s proposed pacemaker coverage for symptomatic bradycardia? Pennsylvania Subscriber Answer: In line with its proposed decision memo, Medicare has decided “the following indications are covered for implanted permanent single chamber or dual chamber [...]
Take the opportunity to review the proposed decision. CMS has posted a proposed decision memo for single-chamber and dual-chamber cardiac pacemakers. The proposed covered indications both relate to symptomatic bradycardia: Documented symptomatic bradycardia due to sinus node dysfunction Documented symptomatic [...]
Home care is the cheapest care setting for post-acute care, and now the industry has the stats to back up that long-held assertion. A study conducted by Dobson DaVanzo & Associates and commission by the Alliance for Home Health Quality [...]
Get friendly with your physician databases. You won't have any financial recourse if Medicare denies an episode that's supposed to pay thousands due to referring physician eligibility. So you'd better make sure your claims are free of such problems. "When [...]
Question: Is there a new code for INFeD iron dextran? My J1751 claims are being denied. Indiana Subscriber Answer: HCPCS 2009 replaced J1751 (Injection, iron dextran 165, 50 mg), J1752 (Injection, iron dextran 267,50 mg), and Q4098 (Injection, iron dextran, [...]
RHHI tells agencies how to ID their PPS adjustments. A correction for a nagging PPS claims problem is coming, but not anytime soon -- leaving you vulnerable to incorrect payments in the meantime. The Centers for Medicare & Medicaid Services will [...]
