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Click here for more sample CPC practice exam questions and answers with full rationale

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

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

Pay-per-view: CMS shifts 2-midnight rule responsibility to QIOs, finalizes packaging expansion

CMS finalized its proposals regarding the 2-midnight rule, including moving responsibility for rule enforcement and education from Recovery Auditors to Quality Improvement Organizations (QIO). This latter change occurred October 1, 2015.

For stays in which the physician expects the patient will need less than two midnights of hospital care, inpatient admission may be allowed on a case-by-case basis determined by the judgment of the admitting physician. The documentation must support the admission and will be subject to review by a QIO. CMS expects inpatient admission for minor surgical procedures to be unlikely and will prioritize those cases for medical review. For hospital stays expected to last two midnights or longer, CMS policy remains unchanged.
 
Continue reading "CMS shifts 2-midnight rule responsibility to QIOs, finalizes packaging expansion" on HCPro’s website. Subscribers to Briefings on APCs have free access to this article in the January issue. 

HCPro.com – APCs Insider

Pay-per-view: Accuracy is paramount for providers when reporting CMS’ new modifiers for 2016

Providers often struggle with modifiers—even those they’ve had available to report for many years—due to the unique scenarios they face at their facilities, staffing changes, and/or unclear or lacking authoritative guidance.
 
Starting January 1, 2016, CMS requires three new modifiers for providers to report. The good news is that it’s pretty clear when they must be reported, but the bad news is that it will take some time to determine the best way for each provider to operationalize them.

 

Continue reading "Accuracy is paramount for providers when reporting CMS’ new modifiers for 2016" on HCPro’s website. Subscribers to Briefings on APCs have free access to this article in the January issue. 

HCPro.com – APCs Insider