OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC DRG Code 320

Watch out for Type of Bill switcheroo. Keep an eye out for the latest reported billing error holding up your reimbursement. Problem No. 1: “Some recently received hospice and home health (HH) claims [are] changing the submitted Type of Bill [...]

Secondary diagnosis codes provide payers with additional details. Although urology practices don’t see injured patients as frequently as certain other specialties, you’ll still find occasions when a patient’s condition occurs due to an external cause. When that happens, you should [...]

Caution: AKS issues remain an OIG sticking point. With the pandemic largely in the rearview mirror, you may be revising your policies and heaving a sigh of relief. But don’t get too comfortable — federal enforcers aren’t taking any breaks [...]

Check for instrumentation, graft coding opportunities. When a patient needs a spinal fusion procedure, there are a variety of techniques and approaches that your surgeon could use. Which one you choose will depend on how the notes represent the encounter. [...]

LUPA threshold decreases far outweigh increases for next year. While halving the massive productivity payment cut is the major reimbursement provision of the 2023 home health final rule, other requirements will also impact home health agencies’ payments. For example: The [...]

Feds Focus on PHE Tricksters and Recover Pay. COVID-19-related fraud and abuse are the prime target of recent audit and enforcement action by the Department of Health and Human Services (HHS) Office of Inspector General (OIG). Let us walk you [...]

A larger diagnosis coding PDGM revamp is afoot. How will recalibration of key PDGM components affect your bottom line? You’d better check out the numbers to figure it out. “This rule touches several key areas of PDGM, from coding to [...]

Plus: See the biggest Medicare fraud cases. If you thought healthcare fraud enforcers primarily focused on upcoding and unbundling, think again. The reality is that the HHS Office of Inspector General (OIG) is always looking for issues to investigate, and [...]

Looks like hospices will be under heavy scrutiny for some time to come. If you need a reminder of why your agency may be under the feds’ microscope, look no further than the HHS Office of Inspector General’s Semiannual Report [...]

Watchdog agency urges tightening up of hospice bundling. If you need a reminder of why your agency may be seeing unprecedented scrutiny, look no further than the HHS Office of Inspector General’s Semiannual Report to Congress. “For every $1 invested [...]