Posts Tagged ‘outpatient’

The Centers for Medicare & Medicaid Services (CMS) has determined that its blanket of non-coverage for blood flow measurement using magnetic resonance imaging (MRI) technology contradicts its policies and magnetic resonance angiography (MRA). CMS has eliminated that from the national coverage determination (NCD), effective Sept. 28, and is allowing payers to choose to cover the services.  This will impact four codes in January’s outpatient code editor (OCE).

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Indiana University School of Medicine researchers say hospital discharge summaries are “grossly inadequate” at documenting tests with pending results.

They justify this statement based on their recent study, “Adequacy of Hospital Discharge Summaries in Documenting Tests with Pending Results and Outpatient Follow-up Providers,” published in the September Journal of General Internal Medicine.

Of the 668 patient discharge summaries reviewed in the study, up to 41 percent of those patients were discharged with test results pending, and about 9 percent of those tests required changes to patient care. However, researchers found only 482 of 2,927 (16 percent) tests pending results were even mentioned. Only 13 percent of the discharge summaries actually documented all tests with pending results. About 75 percent of the discharge summaries did not mention any tests pending results at all.

This creates a real continuity-of-care challenge for primary care physicians.

“Physicians are doing a terrible job during the transition of care of informing the follow-up [practitioners] about what they should know about a patient’s pending tests,” said the study’s lead author, Martin C. Were, M.D., assistant professor of medicine at Indiana University School of Medicine and a research scientist at the IU-affiliated Regenstrief Institute, Inc.

The Indiana University researchers blame poor communication during care transition between inpatient and outpatient settings.

“Errors in communication reportedly contribute to over half of all preventable adverse events and are associated with twice as many deaths when compared with errors due to clinical inadequacy,” researchers state in the study.

CGI Federal’s first set of approved issues for Recovery Audit Contractor (RAC) review in Region B is now available.

Following HealthDataInsights and Connolly Healthcare’s lead, the approved issues target outpatient hospital and physician claims and include blood transfusions, IV hydration, and bronchoscopy services.

All three RACs will be looking for overpayments due to excessive units reporting. For blood transfusions, IV hydration, and bronchoscopy services, you should bill a maximum of 1 unit per patient, per date of service.

Look for additional information regarding these RAC-approved issues, including affected codes and policy-related links, on CGI’s Web site.

If audited, a provider has an initial discussion period to present additional information to support the services billed. If the provider does not agree with the decision, then the provider has 120 days from date of the First Demand Letter to file an appeal of the determination.

On Oct. 6, 2008, the Centers for Medicare & Medicaid Services (CMS) announced that CGI Technologies and Solutions, Inc. of Fairfax, Va., was awarded Region B, initially working in Indiana, Michigan and Minnesota and later adding Illinois, Kentucky, Ohio and Wisconsin.

CGI may be contacted by phone at (877) 316-7222 and by e-mail at racb@cgi.com.

Wisconsin’s 60 ambulatory surgical centers (ASCs) may soon incur a tax that would raise state revenue $44 million over two years, Outpatient Surgery reports in its June 2 e-weekly newsletter.

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The Centers for Medicare & Medicaid Services (CMS) recently updated its Medicare benefit and claims processing policies to reflect National Coverage Determinations (NCD) for noncoverage of certain surgical never events.

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An expansion of the 453.x (embolism and thrombosis) range should help you precisely select your ICD-9-CM codes in 2010.

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A rash of Office of Inspector General (OIG) reports has uncovered millions of dollars in Medicare overpayments to various acute care hospitals between the years 2004-2005. A failure to update systems with new Medicare guidance caused hospitals to incorrectly bill oxaliplatin service units, the OIG finds.

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Three Minnesota hospitals have agreed to pay the federal government $2.28 million to settle allegations that they overcharged Medicare during a five-year period.

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A recent review conducted by Trailblazer, the A/B Medicare Administrative Contractor (MAC) for jurisdiction four (J4), shows hospitals are ultimately confused as to where to draw the line between inpatient and outpatient status. Even more recent editorial changes to the Medicare Claims Processing Manual may help hospitals clarify the terms “observation” and “admission.” Read more »

The July 2009 update of the hospital Outpatient Prospective Payment System (OPPS) implements a number of changes to and billing instructions for various Medicare policies. The most affected areas of note are drugs and biologicals and Part B hospital outpatient services.

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