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Tag Archives: Negative

Pay-per-view: CMS backs off some burdensome proposals but imposes negative payment update in latest rule

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The 2016 OPPS final rule includes the first negative payment update for the system, but CMS also listened to commenters’ suggestions to make a variety of proposals less onerous either operationally or financially.

"CMS’ language is quite firm in parts of the rule when explaining why some proposals were finalized, but the agency also showed its willingness to listen to providers who submitted detailed comments for other proposals," says Jugna Shah, MPH, president and founder of Nimitt Consulting, based in Washington, D.C., and Spicer, Minnesota.
 
Continue reading "CMS backs off some burdensome proposals but imposes negative payment update in latest rule" on HCPro’s website. Subscribers to Briefings on APCs have free access to this article in the January issue. 

HCPro.com – APCs Insider

ROS negative except as documented in HPI question

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I would appreciate any thoughts on this as there isn’t agreement in my office. Would this be acceptable documentation for a 10pt ROS?

Thank you?

Review of Systems Constitutional: Negative except as documented in history of present illness.
Eye: Negative.
Ear/Nose/Mouth/Throat: Negative.
Respiratory: Negative except as documented in history of present illness.
Cardiovascular: Negative except as documented in history of present illness.
Gastrointestinal: Negative.
Genitourinary: Negative.
Musculoskeletal: Negative.
Neurologic: Negative.
Psychiatric: Negative.

Medical Billing and Coding Forum

Negative Response for HPI Elements

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Hi,

I know this question has been asked in the forum but I wanted to see if there was any difference in opinion now. Can we use Negative response for HPI elements? Such as negative for trauma or patient hasn’t take any medication. If anyone has any guidelines to support, it would be greatly appreciated.

Thank You

Medical Billing and Coding Forum

Help: ROS negative findings– what is appropriate?

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I have always been taught that in auditing a chart note that the word "negative" will not count, and for at least one body system needs to specify the negative findings and then the provider can say all other systems negative. Is this correct? Does anyone know What Medicare rules are? I am dealing with questions from a provider right now, who wants something in black and white explaining the rationale behind this.
Thanks for your time

Medical Billing and Coding Forum

Appendectomy with negative path

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I have a patient who came in through the ED with a positive CT of the lower quadrant signifying possible appendicitis . The patient is taken to the OR , The physician does a laparoscopic appendectomy with abdominal lavage , he find the patient has a hemorrhagic ruptured ovarian cyst, this is why he done the lavage (49320) , to clear out the caviety from blood.
The appendix path comes back as completely normal .

My question : The intent of this surgery was to remove the appendix because of possible appendicitis , but it ended up being negative in the end .
As far as I know, the surgeon can go ahead and bill for the laparoscopic appendectomy , however there is a strong possibility of denial .
I have googled, and researched local websites and I can’t find any solid proof of the "rules" for when something like this happens. Is it ok to bill this procedure?
Can anyone show me any proof of why this is ok?

Medical Billing and Coding Forum

Tip: CMS issues first OPPS negative payment update

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CMS finalized its proposal to reduce the conversion factor by 2% to account for its overestimation of dollars for packaged labs built into the 2014 APC rates, despite congressional and provider pressure to not proceed with this payment reduction.
 
The 2% reduction, along with other adjustments, results in decreasing APC payment rates under the OPPS by 0.3% in 2016. This will lower payments to hospitals by approximately $ 133 million compared to 2015, excluding estimated changes in enrollment, utilization, and case mix.
 
CMS will also continue to implement a statutory 2% payment reduction for hospitals that fail to meet hospital outpatient quality reporting requirements.

 

This tip is adapted from “CMS backs off some burdensome proposals but imposes negative payment update in latest rule” in the January issue of Briefings on APCs.

HCPro.com – APCs Insider

Pace Yourself in 2017 to Avoid Negative Payment Adjustment in 2019

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The physician community has been in a bit of a tizzy since April, when the Centers for Medicare & Medicaid Services (CMS) issued a notice of proposed rulemaking for implementing its Quality Payment Program (QPP) — and with good reason. The expectation for eligible clinicians to begin performance reporting at the start of 2017, or […]
AAPC Blog