Look up a DRG code to immediately get the fee details from IPPS and LTCH PPS, including type, relative weight, Geometric Mean LOS, Arithmetic Mean LOS, and more.
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Question: How do you code a history of elevated prostate-specific antigen (PSA)? AAPC Forum Participant Answer: There is no specific history code for elevated PSA levels, which often occur in patients with prostate cancer and various other noncancerous conditions. The best possible [...]
Despite funding cuts HHS and company remain vigilant in their fight to recover assets. As the stakes continue to rise in healthcare, the opportunity for fraud increases. A recent Office of Inspector General (OIG) publication illustrates that offenders continue to [...]
Therapy episodes would get reimbursed less. If your claims are dominated by episodes with high therapy, no recent hospital stays, or patients with behavioral health conditions such as schizophrenia, bipolar disorder or drug addiction, Medicare’s draft for HH PPS payment [...]
Question: A patient came in for a well check. The pediatrician ordered a urinalysis, which came back abnormal. The child came back in the next day to repeat the test, which came back normal. For the second test’s diagnosis, should [...]
Medicare is falling behind on testing curative care for beneficiaries, report Politico and Kaiser Health News. The 2010 Affordable Care Act tells the Department of Health and Human Services to select up to 15 sites to test concurrent care for [...]
Medicare is falling behind on testing curative care for beneficiaries, report Politico and Kaiser Health News. The 2010 Affordable Care Act tells the Department of Health and Human Ser-vices to select up to 15 sites to test concurrent care for [...]
The HHS Office of Inspector General released a report May 1 that reviewed interrupted stays at inpatient rehab facilities between 2004 and 2005. "Our nationwide computer match showed that 448 IRFs billed incorrectly for 986 interrupted stays during that period," [...]
Scenario: Resident A needs radiation therapy. So, the facility contacts the vendor to obtain the HCPCS codes for the services the resident will be receiving. The SNF billing office checks the codes against the SNF HCPCS help file and finds [...]
DOJ boast sheet touts record-setting fraud haul. Think health care fraud enforcement is easing up after years of aggressive scrutiny? Think again. The feds collected a record-setting $1.6 billion from providers, suppliers and others they suspected of ripping off the Medicare and [...]
Hospitals and laboratories will be negotiating a flurry of new contracts soon if the General Accounting Office gets its way. In a recent report, the GAO calls on the Centers for Medicare & Medicaid Services to stop making direct payments [...]
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