Special Bulletin

RAC issue for IRFs has moved from being proposed to being approved. The Centers for Medicare & Medicaid Services (CMS) recently posted a potential Complex Medical Review for (inpatient rehabilitation facilities) IRFs. The issue: 0A024-Inpatient Rehabilitation Facility (IRF) Stays: Meeting Requirements in the proposed Recovery Audit Contractors (RAC) Topics list…
CMS says proposal will save U.S. healthcare facilities $1.12 billion annually. In a surprise move, the Centers for Medicare & Medicaid Services (CMS) has released proposed rule CMS-3346-P to, in the words of its title, “Promote Program Efficiency, Transparency, and Burden Reduction.” The proposed rule contains regulation changes applicable to…
EDITOR’S NOTE: The following article was originally published on the American College of Physician Advisors (ACPA) blog by the author. I never really understood how my “square peg” of work as a geriatrician was supposed to fit into the “round hole” of evaluation and management (E&M) CPT® coding with its…
Error reported by WPS/GHA  might have nationwide ramifications. Medicare Administrative Contractor (MAC) WPS GHA today confirmed that an enhancement to its Fiscal Intermediary Shared System (FISS) caused erroneous additional documentation request (ADR) letters to be sent to providers. In a posting to its website, WPS GHA reported that the error…
A proposed 50 percent reduction in claims submitted with modifier 25 is on the table. The Centers for Medicare & Medicaid Services (CMS) is proposing a 50 percent reduction in reimbursement for claims submitted using modifier 25, according to Shannon DeConda, an evaluation and management (E&M) coding expert. DeConda reported…
Changes to the inpatient admission order regulations are significant  The Centers for Medicare & Medicaid Services (CMS) has posted the 2019 Inpatient Prospective Payment (IPPS) Final Rule, which changes inpatient admission order regulations. The Final Rule was published Thursday in the Federal Register. “The inpatient admission order regulations are a…
CMS proposal is big news for ambulatory surgery centers. There is big news for ambulatory surgery centers (ASCs) as the Centers for Medicare & Medicaid Services (CMS) is proposing to allow 12 cardiac catheterization procedures to be performed in ASCs, according to the 2019 Outpatient Prospective Payment System (OPPS) proposed rule…
As expected, the Centers for Medicare & Medicaid Services (CMS) posted the 2019 Outpatient Prospective Payment System (OPPS) proposed rule online on Wednesday. And, also as expected, the document weighed in at more than 750 pages. RACmonitor contributor Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, will report…