Blogs

Shared Services – Truth In Billing

By Jana Weis, Principal, Gill Compliance Solutions, LLC.

As consultants in the healthcare industry, we are asked all kinds of questions on a daily basis.  Yet, if I were to add up the number of times clients ask about shared services, it would likely be on the top of the list.  Shared services seem like an easy concept, two providers’ participation in the care of a patient, right?  Well, almost right. 

Let’s first take into consideration the CMS language surrounding shared services:

Claims Adjudication and Payer Rules under ICD-10

Rayellen Kishbach's picture

Because we process thousands of LCDs updates weekly for our Coding Suite, we often get some insights that we can share. With the implementation of ICD-10, a significant drop off in the number of local coverage determinations (LCDs) and coverage articles published by the Medicare Administrative Contractors (MACs) has occurred. (See table in the white paper link below). While this may be partly due to MAC consolidation, it has left providers with less guidance than before about the proper coding and billing of covered services.

How health care economics teams communicate with payers (and other healthcare entities)

Rayellen Kishbach's picture

In January 2017, the FDA released draft guidance specifying the nature of communications between manufacturers and payers: The first draft guidance, entitled “Drug and Device Manufacturer Communications with Payers, Formulary Committees, and Similar Entities--Questions and Answers,” provides answers to common questions regarding communications of health care economic information (HCEI) about their approved prescription drugs to payers.

Keeping up with MS-DRG Revisions

Rayellen Kishbach's picture

CMS has issued two errata and correction notices for how MS-DRG logic functions in FY2017. These changes may impact payment. This article highlights a few examples.

It is important to note that CMS published v34 r2 in time for implementation on 10/1/2016, but the v34 r3 was released after claims for FY2017 had begun, so improper payments may have occurred.

Be Prepared for Changes in Billing Discarded Drugs/ Biologicals

Christina Panos's picture

By Christina Panos, RHIA, CTR

Original post on 6/9/2016 updated on 6/10/2016 to reflect announced delay.

The Centers for Medicare and Medicaid Services (CMS) has maintained a long-standing policy that provides payment for the discarded portion of single-use vials/packages.  While coverage is not changing, the associated drug wastage billing requirements are about to change.

Understanding non-covered codes – help for denials management and pre-payment review edits

Rayellen Kishbach's picture

Wouldn't it be great if there was just ONE LIST of procedure codes published somewhere by Medicare to identify non-covered services? Unfortunately, there isn’t one, but a quick review of the information that is provided by Medicare can get you there.

Supporting Compliance in the New World of Remote and Outsourced Coding & Billing.

Rayellen Kishbach's picture

According to a recent HIM Benchmark Report, HIM department managers equally ranked Coder Productivity, Quality, and Managing Financial Metrics as their biggest challenges, while that same report noted that close to 60% of HIM professionals outsource a portion of their coding needs. Even without direct outsourcing, we notice an increase in the opportunity to do coding and billing work remotely.

Understanding MS-DRG Grouping under ICD-10

Rayellen Kishbach's picture

Now that ICD-10 is in full swing, we are seeing a lot of activity with providers, payers, consultants and regulators who need to understand how Acute Inpatient and Long Term Care Hospital claims "behave" when the claim is coded in ICD-10. This includes both prospective and retrospective review of claims scenarios to understand MS-DRG grouping. This article offers a basic primer on MS-DRG grouping logic, and research techniques for using related MediRegs Coding Suite tools.

OIG Releases New Compliance Oversight Document for Health Care Governing Boards

Darci Friedman's picture

On April 20th, Daniel R. Levinson, the Inspector General for the Office of Inspector General ("OIG"), U.S. Department of Health and Human Services ("HHS") delivered an address at HCCA's 19th Annual Compliance Institute. He was his usual captivating, thoughtful self, delivering a few gems for those in attendance. One of those gems was that that day the OIG released a new document for the industry titled: Practical Guidance for Health Care Governing Boards on Compliance Oversight ("Practical Guidance").

OCR Releases a New Version of Guide to Privacy and Security of Electronic Health Information

Darci Friedman's picture

The Office of Civil Rights recently released Version 2.0 of its' Guide to Privacy and Security of Electronic Health Information ("Guide"). This new version of the Guide provides updated information about compliance with the Medicare & Medicaid Electronic Health Record (EHR) Incentive Programs' privacy and security requirements as well as the HIPAA Privacy, Security, and Breach Notification Rules. You can access the updated document on your MediRegs product, with the OCR data in the HIPAA Library.

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