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Brace for new burdens, risks in new OSHA rule requiring work injury reports

07/04/2016

Prepare to walk a fine line between roles as a health care provider and an employer when a new rule takes effect Jan. 1 requiring work-related injuries and illnesses to be reported through an electronic database.

ICD-10-CM addendum provides details for new, current diagnosis codes

07/04/2016

by: DecisionHealth Staff

More than 3,000 changes and impactful revisions in tabular instruction are coming to ICD-10 when the fiscal year 2017 code set takes effect on Oct.1. CMS posted the final full addenda list along with an updated tabular, alphabetic index, neoplasm table, table of drugs and chemicals and index of external causes on June 22.

Splinted before surgery? If you’re admitted, the office charge goes away

07/04/2016

by: Roy Edroso

Question: We saw a patient in our office with a fractured ankle to which we applied a short splint (29515). He was admitted to our local hospital the same day and had ORIF [open reduction internal fixation] the following day. Medicare has denied our claim, saying he was an inpatient because of the admission. On what grounds can we appeal?

Specialties fare well with initial critical care services, struggle with add-on code

07/04/2016

by: Richard Scott

Among the five specialty groups that bill critical care codes 99291-99292 most often, the highest denial rate, for 99291 (Critical care delivery critically ill or injured patient, first 30-74 minutes), stands at a reasonable 8.3%, which is what cardiologists tallied in 2014.

Avoid shared-service billing, time miscalculations for critical care codes

07/04/2016

by: Richard Scott

Avoid miscalculating the time your providers spent with a critically injured patient when you report critical care services (99291-99292) to avoid an unintended upcharge – and a potential recoupment of payment.

Shared Savings rule finalized; lower-performing ACOs get a break

07/04/2016

by: Roy Edroso

The Shared Savings rule finalized on June 6 makes things slightly easier for new entrants in the Medicare ACO program — particularly those in high-cost areas.

OIG cites lax oversight of provider-based clinics, urges elimination of pay disparity

07/04/2016

by: Scott Kraft

The provider-based designation for physician clinics owned by hospitals continues to cause problems, including overpayments due to coding errors and lax oversight of whether facilities designated as provider-based clinics meet Medicare requirements, the HHS Office of Inspector General (OIG) charged in a recent report.

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