As compliance professionals, the concept of an “unlikely” physician day is not a new risk area. Conducting data analysis of time-based services to identify instances where billings frequently exceeded a set number of hours per day has been commonplace in most organizations for many years. However, with the change in
The OIG issued their August Work Plan. The update includes plans to evaluate whether Medicare paid physicians for hyaluronic acid knee injections in accordance with Medicare requirements. The FDA and CMS have published strict indications for use and coverage including, but not limited to: Symptomatic osteoarthritis (OA) of the knee with
CMS recently posted the 2025 ICD-10-CM files that contain code additions, revisions and deletions to the code set. The implementation date of October 1, 2024 is fast approaching. The 2025 ICD-10-CM coding changes include: Addition of 252 new codes Revision of 13 codes Deletion of 36 codes The ICD-10-CM
CMS has released the 2025 Proposed Medicare Physician Fee Schedule. The proposal contains many significant coding and coverage provisions including: 2.93% payment decrease Permanent coverage of audio only encounters under telehealth when all other criteria are met Extension of the waiver of frequency limitations on subsequent hospital, nursing facility, and
CMS released the 2025 OPPS and ASC Proposed Rule this morning. The 984 page document contains a number of important proposals including: 2.6% payment increase for eligible hospitals New conditions of participation (CoPs) for obstetrical services Updates to the Intensive Outpatient (IOP) and Partial Hospitalization (PHP) programs Separate payment for
The OIG conducted an audit to evaluate the effectiveness of Medicare program safeguards to ensure appropriate reimbursement of short stay inpatient admissions. In general, inpatient admissions which are not expected to last at least two midnights are not considered to be appropriate. However, an inpatient stay of less than two
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