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Top Stories
- CMS releases 2013 OPPS final rule
CMS released the 2013 OPPS Final Rule on November 1, which finalizes APC payment system changes for 2013 but hospitals will need to read the 2013 Medicare Physician Fee Schedule (MPFS) Final Rule to find some of the biggest operational changes facing them in 2013.
- Solidify processes to avoid HAC penalties
Hospital-acquired conditions (HACs) remain in the spotlight in the 2014 IPPS proposed rule even though CMS did not add any new conditions to the HAC list. Under the Affordable Care Act, CMS is required to penalize hospitals that are in the lowest-performing 25% for eight HACs. Beginning in 2015, those facilities would receive only 99% of what they would otherwise be paid under IPPS.
- CMS looking for comments on molecular pathology payments
The AMA revamped coding for molecular pathology beginning in 2012 and continuing in the 2013 CPT® Manual. As a result, coders went from reporting stacked codes—one code for each part of a molecular pathology test—to reporting a single code for the entire test. Now CMS is trying to determine how to pay for those tests and the agency wants to hear from providers.
- Q/A: How should we report irradiated blood products?
Q: We have patients who have received a lot of blood and now the orders are for irradiated blood. We have been doing this in-house and our radiology department has been generating a charge. We just received a claim rejection for the combination of CPT® code 86945 (irradiation of blood product, each unit) and P9040 (red blood cells, leukocytes reduced, irradiated, each unit). We changed it to CPT 86945 and P9021 (red blood cells, each unit), but this was rejected for unbundling. How should we be reporting irradiated packed cells?
- Tip: Keep an eye on evolving molecular pathology codes
Why do some molecular pathology codes clearly list variants as examples, not an exclusive list, while other codes don’t? The answer may lie in the rapid scientific advances that are being made for some gene mutations and associated tests. This may explain why the code for FLT3 was created to cover only the ITD variants, for example, even though there are other variants of interest such as the D835 variant.
- Keep an eye on compliance
How robust is your facility’s compliance program? When did you last update it? Do you know how well it’s working? Several healthcare facilities have been hit with fines for attempting to defraud Medicare. Make sure you aren’t next on the list.
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