Panacea has summarized the Centers for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA) payment and coding updates being implemented during this public health emergency into the following sections:
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With the CMS Final Rule published there is a flurry of activity across the industry to come up to speed on the changes. In our experience though we’ve found that for many healthcare systems it’s easier to keep track of changes to the codes, rules, and guidelines they are already using; the challenge comes in becoming aware of and implementing when new things are introduced.
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On January 1, 2019 the Hospital Price Transparency Rule took effect mandating hospitals publish their price lists online in a machine-readable format. Hospitals complied by making their charge description master (CDM) available via download in CSV or similar format. The result fell far short of CMS’ goal of empowering patients to become “active healthcare consumers” and the agency on July 29, 2019, in response to the Trump administration Executive Order on Price and Quality Transparency, proposed expanded rules aimed at more “consumer friendly” transparency.
We’ve summarized the Centers for Medicare and Medicaid Services (CMS) and American Medical Association (AMA) payment and coding updates being implemented October 1, 2019. The updates should be reviewed for possible implementation in your hospital chargemaster and/or reviewed by applicable coding and billing staff.
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As laboratory services are one of the highest revenue-producing departments in most health systems, it’s incredibly important to bill these services correctly. However, it’s also an area fraught with lots of guidelines and restrictions—and with many staff members throughout the hospital system working laboratory accounts, there is a high risk of errors and inconsistencies. This is a situation we’ve seen and helped correct in health systems nationwide.
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On August 2, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that was intended to empower patients through better access to hospital price information. Current laws already required hospitals to make public a list of their standard charges, but the new requirement which became effective on January 1, 2019, required hospitals to publish a list of all charges in machine readable format via the internet, in an XML or CSV format. The final rule also required providers to update their posted charges no less than one time per year.
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Learn a new holistic approach to physician auditing using technology, expertise, and education. With a predictive analyzer tool, you can identify incidents and patterns of potential billing and coding as well as opportunities where under-coding of services may be taking place. The results will drive meaningful focused audits and provider specific education.
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In today’s environment of increasing regulatory oversight and ever-changing reimbursement policies, compliance must be more than a checkbox. Though an annual compliance and audit plan is not legally mandated, there are few healthcare organizations that don’t have compliance on their radars. However, if your compliance focus is simply to check a box, you’re missing out.
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With two-year’s worth of Medicare claims data now available under the ICD-10 coding guidelines, we no longer need to guess about the impact of the new coding and documentation requirements and the industry readiness.
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