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Archive for Billing and reimbursement

Nov
19

Tip: Submitting claims for laboratory services

Posted by: Compliance Monitor | Comments (0)
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Your hospital should ensure that all claims for clinical and diagnostic laboratory testing services are accurate and correctly identify the services ordered by the physician (or other authorized requestor) and performed by the laboratory. The OIG recommends that your hospital’s written policies and procedures state that:
 
  • The hospital bill for laboratory services only after they are performed
  • The hospital bill only for medically necessary services
  • The hospital bill only for tests actually ordered by a physician and provided by the hospital laboratory
  • The current procedural terminology or Healthcare Common Procedural Coding System code used by the billing staff accurately describes the service ordered
  • The coding staff submit only diagnostic information obtained from qualified personnel and contact the appropriate personnel to obtain diagnostic information in the event that the individual who ordered the test has failed to provide such information
  • The hospital document receipt of diagnostic information obtained from a physician or the physician’s staff after receiving the specimen and request for services
  • Routine audits be conducted to assess your billing compliance with the regulations
This week’s tip was adapted from The Compliance Officer’s Handbook 2nd Edition. For more information about the book or to order your copy, visit the HCMarketplace.
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Nov
17

CMS Public Events: Hospital Open Door Forum

Posted by: Medicare Weekly Update | Comments (0)
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The next Hospital & Hospital Quality Open Door Forum is scheduled for 2 p.m. Eastern, Thursday, November 19. To access the call, 800/837-1935 and reference conference ID: 34708559.

A transcript and audio recording of the conference call will be available to MedicareFind subscribers approximately one week after the Open Door Forum is held.

Nov
12

RAC vs. CERT audits: Do you know the difference?

Posted by: The RAC Report | Comments (0)
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The Comprehensive Error Rate Testing (CERT) Hospital Payment Monitoring Program is one of the ways CMS is trying to improve the quality and accuracy of Medicare claim submission and payment of those claims. Is that so different from what the RAC program is designed to do?
 
While the end-goal may be the same, the methodology is very different. Stacey Levitt, RN, MSN, CPC, director of patient care management at Lenox Hill Hospital in New York City, outlines some of the important differences between the two types of Medicare audits:  Read More→
Nov
11

Clearing up condition code 44 confusion

Posted by: Case Management Weekly | Comments (0)
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Hospitals must meet certain criteria before they use condition code 44. Consider this example. A patient experiencing chest pain presents to a hospital Saturday night. The hospital does not have weekend case management coverage, so the physician admits the patient as an inpatient. During this time, the physician orders tests, chest x-rays, and other services.
  Read More→
Nov
11

ZPICs have begun in Zone 4

Posted by: Case Management Weekly | Comments (0)
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The following article is excerpt from HCPro’s newest resource for hospital case managers—www.CaseManagementMentor.com—a free blog dedicated to connecting hospital case managers to industry pacesetters, peers, and best practices.
 
Health Integrity LLC, the Zone Program Integrity Contractor (ZPIC) for Zone 4 (Colorado, New Mexico, Oklahoma, and Texas) has begun requesting medical records for review.
 
ZPICs are Medicare audit contractors that specifically identify cases of fraud and abuse.  ZPICs may “take immediate action to ensure that Medicare Trust Fund monies are not inappropriately paid out and that any mistaken payments are recouped,” according to the Medicare Program Integrity Manual. Read More→
Nov
10

Signature for Laboratory Tests, Clarification in the MPFS Final Rule

Posted by: Medicare Weekly Update | Comments (0)
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By Kimberly Anderwood Hoy, JD, CPC

This week, I would like to review a “clarification” regarding physician signatures on orders for clinical diagnostic testing that came out in the Final Rule for Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for 2010. Although this publication is hospital-directed and we do not normally report on physician fee schedule issues, this “clarification” could affect hospital policies on obtaining signatures for the laboratory services they provide.

Click over to the MedicareMentor Blog to read more.


Nov
10

CMS extends comment period for proposed ESRD PPS

Posted by: Medicare Weekly Update | Comments (0)
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CMS extends ESRD PPS comment period

On November 4, CMS published a notice in the Federal Register to extend the comment period on its proposal to initiate a prospective payment system (PPS) for end-stage renal disease (ESRD). The comment period on the ESRD PPS proposed rule will now end at 5 p.m., December 16.

View the notice of extension.

Submit a comment.

Nov
03

CMS releases 2010 OPPS final rule

Posted by: Lori Levans | Comments (0)
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The 2010 OPPS final rule released on October 30 contains few surprises, but does finalize two changes that received considerable attention when CMS proposed them.

“The information CMS has finalized for physician supervision and drug reimbursement are two key areas for hospital review, though for slightly different reasons,” says Jugna Shah, MPH, president of Nimitt Consulting in Washington, DC.

Click here to read more.