Healthcare News
The 2021 Proposed Rule for Inpatient Prospective Payment System (IPPS) was released on May 11, and will be published in the May 29, 2020, Federal Register (2020). Provisions in the rule increase the Medicare IPPS rate for hospitals that report quality data and are meaningful users of EHRs by approximately 3.1%, resulting in an increase of $2.07 billion in spending. With other adjustments, the overall payment increase for inpatient hospitals will be around 1.6%. The Proposed Rule adjusts the payment rates, MS-DRG codes, and other provisions, including new ICD-10-CM and ICD-10-PCS codes.
The Refresh With YES: PCS Head and Neck Procedures Webinar dives into the definitions, procedures, and approaches for various head and neck operations divided into 16-18-minute modules. Learners will find out how to assign the right PCS code for head and neck procedures during the following four modules within this course: Craniotomy/Craniectomy Overview and Approach, Craniotomy/Craniectomy Procedures, Sinus Procedures, and Ventriculoperitoneal Shunt Procedures.
The Centers for Medicare & Medicaid Services (CMS) has decided Medicare will expand its payment protocol for professional Medicare telehealth services provided to beneficiaries in all areas of the country, in all settings. “Telehealth, telemedicine, and related terms generally refer to the exchange of medical information from one site to another through electronic communication to improve a patient’s health” (CMS, 2020). Due to the current Public Health Emergency (PHE) declared for 2019 Novel Coronavirus (COVID-19), this expansion was considered a necessary step to assist in healthcare reimbursement and only designed to last as long as this emergency
This article offers guidelines on Coding COVID-19 suspected Infection & Symptoms. Symptoms of the Coronavirus, according to the CDC, include cough, shortness of breath, fever, chills, muscle pain, headache, sore throat, and loss of taste and smell (2020). The reporting guidelines dictate: In patients with acute bronchitis that has been caused by COVID-19, use codes U07.1 and J20.8. For lower respiratory infection due to COVID-19, assign codes U07.1 and J22.
Healthcare organizations, including coders, often struggle with a true return on investment when aiming to cross-train from outpatient to inpatient coding. There are several key differences between inpatient and outpatient coding. Inpatient coding documents a patient’s diagnosis and treatment during hospitalization, while outpatient coding generates a detailed report for diagnoses treated in one visit. Coding for inpatient vs. outpatient also requires different code sets and payment systems.
CMS released the Medicare telemedicine coding and reimbursement guidelines for healthcare providers to use during the COVID-19 pandemic (CMS, 2020). According to the CMS Medicare Telemedicine Health Care Provider Fact Sheet, reimbursement for these visits are considered the same as in-person visits and are paid at the same rate (CMS, 2020). The U.S. Department of Health & Human Services Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs (CMS, 2020).
There are 3 main types of virtual health services physicians and other professionals can provide to Medicare beneficiaries: Medicare Telehealth Visits, Virtual Check-Ins, and E-Visits (CMS, 2020). Providers such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, will be able to offer telehealth to their patients. See more on coding for telemedicine in response to the 1135 Waiver Authority and Coronavirus Preparedness and Response Supplemental Appropriations Act, in our previous article here.
COVID-19, or “Coronavirus Disease 2019,” is an infectious respiratory disease caused by the newly discovered Coronavirus, SARS-CoV-2, that ranges from mild to no symptoms, to severe symptoms and death.
Due to the stay-at-home orders put in effect by state governors and the highly contagious COVID-19 virus, CMS has expanded coverage for its Medicare recipients through the use of telemedicine (CMS, 2020). According to CMS, “The benefits are part of the broader effort by CMS and the White House Task Force to ensure that all Americans – particularly those at high-risk of complications from the virus that causes the disease COVID-19 – are aware of easy-to-use, accessible benefits that can help keep them healthy while helping to contain the community spread of this virus” (2020).
Adapting to the influx of telehealth services in response to the COVID-19 outbreak, CMS has adjusted the “List of services payable under the Medicare Physician Fee Schedule when furnished via telehealth” in order to provide as much support and care as possible (2020). In addition, CMS issued updated criteria for risk adjustment of Medicare telemedicine services, as well as guidelines on how to bill for telemedicine.