The 2024 CPT Manual is available. The update includes 230 new CPT codes, 49 code deletions and 70 revisions. The manual also includes new definitions and instructions pertinent to evaluation and management (E/M) services. One of the most notable changes is the AMA’s new guidance for split or shared services.
The government is increasing enforcement efforts around proper risk adjustment coding (HCC coding). We continue to see regular audit reports detailing significant overpayments due to improper reporting of diagnosis codes. The U.S. Attorney’s Office recently announced a $172,294,350 False Claims Act settlement with Cigna. Like many other recent cases, the
The Medicare 2024 Final Inpatient Prospective Payment Rule has been published. Some notable changes for the upcoming year include: 3.1% increase in operating payments for acute care hospitals (an increase from the proposed rule projection of 2.8%) Individual hospitals may receive a 1% reduction for poor quality performance Individual hospitals
Today, the OIG issued their July Work Plan. The update is heavily focused on risk adjustment coding (Hierarchical Condition Category (HCC) Coding). The OIG announced the following: They will be developing a toolkit for MA plans to use to audit provider reporting of HCC conditions, They will be auditing HCC
CMS released both the 2024 OPPS and 2024 MPFS Proposed Rules. The lengthy proposals contain a number of notable provisions including: 2024 OPPS Proposals: 2.8% payment increase for eligible hospitals Establishment of an intensive outpatient program (IOP) for mental and behavioral health services, as well as, substance abuse services Modification
The OIG has issued their Semiannual Report to Congress for the period October 1, 2022 through March 31, 2023. The report highlights over $1 billion in expected investigative and audit recoveries identified during the first half of FY 2023. The report details the OIG’s ongoing work through investigations and enforcement actions which
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