When looking at the link between readmissions and hospital quality of care, it may be best to focus on patients who return to the hospital seven or fewer days after discharge, according to a recent Health Affairs study.
Q: It is my understanding that we can make PHI disclosures using our EHR for payment/treatment/healthcare operations without a consent and that we do not need to track these requests for an accounting of disclosures. Has this changed?
Case managers around the country are celebrating National Case Management Week, October 9–15, which recognizes the caregiving efforts of case managers throughout the year.
Q: Our state child support enforcement agency requested the medical records of one of our pediatric patients. Are we allowed to respond to this request without a subpoena?
Case managers face countless challenges when dealing with end-of-life care, and with less than 50% of Medicare beneficiaries utilizing hospice programming, changes had to be made.
The North Dakota Department of Human Services’ claims for Medicaid reimbursement for Targeted Case Management Services did not meet all federal requirements and lacked appropriate policies and procedures for claims, according to the Office of Inspector General.
Q: We have started using what our physicians call “high-frequency” neurostimulators. I know there are two HCPCS codes for reporting these to Medicare, but how do we know what is high frequency and what is not?
Q: Rural health clinics have to start to bill all services on individual lines with HCPCS codes and charges. Is there a way to report these services on a separate line without the appearance of inflating our charges?
According to report, at least 50 employees of Northwestern Memorial Hospital in Chicago were fired for accessing the medical record of actor Jussie Smollett without authorization.
As federal agencies release new and complex regulations for acute and postacute care facilities, providers are faced with the daunting task of unraveling and complying with the latest changes while ensuring patients receive quality care.
Q: The influenza virus vaccine represented by CPT® code 90674 (influenza virus vaccine, quadrivalent [ccIIV4], derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use) was approved under the Medicare program as of August 1. However, our claims are kicking back when we report the code. Has there been a change?
The acute kidney injury (AKI) dialysis payment rate is $232.37 for CY 2018, as updated by CMS in the 2018 End-Stage Renal Disease Prospective Payment System (ESRD PPS)
We found out after an observation patient was discharged that one of the procedures performed was an inpatient-only procedure. Can we bill this to Medicare without an official inpatient order on the medical record?
Effective January 1, 2018, Medicare payments for X-rays taken using computed radiography will be reduced by 7%, according to a policy CMS finalized in the 2018 OPPS final rule. This reduction will remain effective until 2022, and increase to 10% beginning in 2023, as required by paragraph 1848 (b)(9) of the Social Security Act.
Q: CMS released guidance last summer about not auditing or counting errors for the specificity of an ICD-10-CM code. CMS is not going to count the code as an error as long as the first three digits are correct. Does this apply to medical necessity diagnoses and edits?
Q: Ever since we moved to an electronic health record (EHR), our HIM department has noticed some physicians copying and pasting information from previous records. How do we know when this is allowed or when we can query the provider to clarify?
The numbers are in and some 12.7 million Americans signed up for a health plan during the Health Insurance Marketplaces open enrollment period. Some 9.6 million people enrolled through HealthCare.gov and 3.1 million through marketplaces in their home state.
Q: We see many assertions that encryption at the right level meets the National Institute of Standards and Technology (NIST)/HIPAA safe harbor provision with no explanation of what is necessary to prove the breached electronic protected health information (PHI) was actually encrypted at the moment of breach. How can a covered entity prove the PHI was actually encrypted at the time of the breach?
Q: Our facility does not often use open-ended queries to physicians. Could you give an example of an open-ended query and any disadvantages they may have?
My understanding is that under the 2-midnight rule CAHs cannot go past two midnights of observation care if the patient has Medicare as a payer. Is that correct?
Q: Are there any new HCPCS codes for recently released biosimilar products on the horizon? Our physicians and pharmacists are being contacted by the manufacturer about purchasing and using them, but we want to be sure we can report them appropriately.
My understanding is that under the 2-midnight rule CAHs cannot go past two midnights of observation care if the patient has Medicare as a payer. Is that correct?
What do you do with a patient who does not have a safe discharge plan, but does not meet inpatient criteria and has been in observation status for 48 hours?
Q: Our pharmacy is asking if there is going to be payment for a new anti-hemophilia factor called Nuwiq. They say it is quite expensive and they want to know if there is additional payment for it.
The majority of patients who visit hospital emergency departments for chest pain do not have a life-threatening condition, according to a recent study in JAMA Internal Medicine.
Q: An investigator from the state health department called the clinic where I work and asked for health records to collect vaccination data for a public health project. Is it a HIPAA violation to share that data?
The American Medical Association recently released eight principles aimed at ensuring healthcare organizations use mobile health applications (mHealth apps) focused on safe and effective patient care.
Have you ever wondered how other HIM professionals work and how their departments operate? Now you can find out! HCPro's HIM Briefings is conducting a benchmarking survey on HIM roles and responsibilities, and we would appreciate your input. Please take a few moments to complete this survey.
Q: We had a patient with hemorrhagic cystitis. Our preprocedural plan was a cystoscopy with a bladder biopsy and cauterization. How should this be reported in ICD-10-PCS? We are having trouble choosing between Control or another root operation, and we are getting different MS-DRGs depending how the procedure is reported.
When it comes to providing high-quality patient care, most American hospitals simply don’t. That’s if the recent round of five-star rankings from CMS are to be believed. About 1,700 hospitals (39%) earned just three out of five stars, an “average” rating, FierceHealthcare reported.
HCPro is gathering information about case management needs for future products. Please take this short survey and we will enter you in a drawing for a free, on-demand HCPro webcast of your choice! Click here to take the survey.
Participation in the Supplemental Nutrition Assistance Program can lead to decreased healthcare claims and out-of-pocket costs for low-income adults, according to a JAMA Internal Medicine study.
The August 2 issue of Revenue Cycle Daily Advisor included a question about benchmark conversion rates from observation to inpatient status. With regard to that question, I think it may be helpful to know the average national conversion rate and average rate for critical access hospitals. Do you have that information?
I was under the impression that CMS said it would leave the billing for self-administered drugs to the OIG. However, we have not heard anything from the OIG. What if we are not billing for the medications?
The overall monthly national healthcare spending rate modestly increased 4.3% from August 2016 to August 2017, with a notable increase in home health spending, according to a brief from Altarum’s Center for Sustainable Health Spending.
Q: In my facility, we are supposed to send an email to our physician advisor (PA) and to administration if a query is not answered within a week. However, this policy doesn’t work well because administration does not do anything with that information, and the PA doesn’t have time to review unanswered queries. Do you have any suggestions concerning when to let a query go unanswered?
CMS’ proposed changes to implement Section 603 of the Bipartisan Budget Act of 2015 and reshape payments for off-campus, provider-based departments represent the most significant changes in the current year 2017 OPPS proposed rule.
CMS’ introduction of CMS-1455-R in March 2013 allowed hospitals to ignore the one-year timely filing deadline and rebill admissions that were denied by an auditor, even many years after the date of service. Fast forward to October 29, 2015, when the OIG released a policy stating that hospitals may waive the cost of self-administered medications to Medicare beneficiaries without concern about inducement or kickback accusations if the hospital develops a policy and applies it uniformly.
Q: We provide tobacco cessation services and have been reporting these with time-based HCPCS codes. There are also CPT® codes for these services. Which is the appropriate set of codes to use for Medicare?
Q: I have a question about navigating the skilled nursing facility (SNF) benefit for Medicare. My understanding is that you can only use a Hospital-Issued Notices of Noncoverage (HINN) for inpatient, so you could use if less than a three-day stay. We have been giving Advance Beneficiary Notices (ABN) for our traditional Medicare patients that are observation when families are not timely on getting a SNF secured to those patients that require it. Is this correct?
Nearly 20% of patients involved in a recent UT Southwestern Medical Center study were discharged from the hospital with one or more unstable vital signs, resulting in a higher number of deaths or readmissions than patients discharged with stable vital signs.
CMS wants your thoughts on its 2017 OPPS proposed changes. In various places in the proposed rule, CMS specifically asks providers to comment on the proposals. You may submit comments to the agency until September 6.
Q: We are struggling with how to report the functional status codes that are required when a physical therapist provides therapy services post-operatively. We have a process for doing that for our “regular” therapy patients, but are struggling with how to implement this for the outpatient surgeries.
With the first data reporting period beginning January 1, 2017, for CMS’ revamped Clinical Laboratory Fee Schedule, the agency has released a user guide and template to aid providers who are required to submit the data.
Q: One of our physicians is talking about a new biological called Inflectra that he is interested in using. Do you have any information on how this is handled under the OPPS?
Q: Our ophthalmologists are using mitomycin after surgery for many of their patients. Do we need to report a HCPCS code for this since it gets packaged into the surgery procedure? It seems like a lot of effort for no money.
I heard the 2-midnight rule is now gone based on changes to Medicare payment rates under the 2017 inpatient prospective payment system final rule. Is this true and if not what changed?
I recently heard of a local long-term care hospital (LTCH, also known as LTACH) that was unwilling to accept military veterans who were cared for at her facility or any Veterans Affairs hospitals even though they would otherwise qualify for LTCH care. The reason the LTCH would not accept these patients was because they did not have a preceding visit in a “regular” hospital. What's the solution?
According to a report published by Change Healthcare, 23.9% of claim denials are due to errors during front-end revenue cycle processes such as registration and eligibility.
An inadvertent change in CMS guidance from “subsection (d) hospital” to “acute care hospital” to “IPPS hospital” resulted in eligible patients being denied admission to long-term care hospitals, but CMS has since revised its guidance.
Medicare beneficiaries sometimes have information about discharge planning from CMS. What questions might they ask as a result of having this information?
Including patients and families/caregivers in daily hospital rounds and bedside conversations can provide patients and their families with better insight into care and enable active participation.
A Comprehensive Error Rate Testing (CERT) study showed insufficient documentation causes most improper payments for arthroscopic rotator cuff repairs, according to the October 2017 Medicare Quarterly Compliance Newsletter.
