STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC DRG Code 327

CMS promises HHAs ample prep time with “early 2020” release. If you think OASIS is a heavy load now, just wait until January 2021. A little over a year from now, the Centers for Medicare & Medicaid Services will add [...]

Stop clogging up the Medicare claims payment system with duplicate RAPs, one HHH Medicare Administrative Contractor says. Problem: From January to March 2017, “16,533 RAPs were rejected with reason code 38157,” MAC CGS says on its website. A RAP rejects [...]

‘Hospice fraud has reached epidemic proportions,’ OIG agent declares. The hospice industry’s efforts to combat its fraud and abuse rep get harder with every enforcement action announced. Check out the latest group of guilty pleas, fraud settlements and prison terms [...]

Hospice medical director relationships are once again in the fraud and abuse spotlight. Lemont, Ill.-based Home Bound Healthcare Inc. and its owner, Romy Macasaet Jr., have agreed to pay nearly $7 million to settle charges of paying kickbacks to referring [...]

Clear documentation of the patient’s progress may keep you in the clear. Your may be the expert in sleep study coding. However, your practice may still face unwanted attention from the auditors if you have not been up to scratch [...]

New OIG report has brought extra attention to services. Your sleep study documentation-or lack thereof-could be a red flag signaling extra attention from auditors. Here's why: On May 20, the Office of Inspector General (OIG) released a report detailing its [...]

Lookout for claim viability if your physicians perform these services. Scrutiny of polysomnography claims, which have been known to be replete with mistakes for some time, is rising. On May 20, the HHS Office of the Inspector General (OIG) released [...]

Medical records were sorely lacking in this audit. Your polysomnography documentation—or lack thereof—could be your calling card for attracting attention from auditors. On May 20, the OIG released a report detailing its audit of sleep study claims paid by Part [...]

Heads up: You'll need multiple codes to help specify the type of apnea. Coding for sleep apnea will include a nice surprise when ICD-10 goes into effect later this year – your diagnoses will actually be easier in some ways [...]

Report other associated sleep conditions with additional ICD-10 codes. When your physician diagnoses sleep apnea, you can breathe easy as the ICD-10 coding system, contrary to expectations, is more simplified than the ICD-9 codes. You now have to report only [...]