The Office of Inspector General (OIG) recently issued a report regarding compliance with the CMS Hospital Price Transparency Rule (HPT rule). Compliance with the HPT requirements was added to the OIG’s Work Plan in 2022 due in part, to concerns raised by congressional and consumer advocacy groups as well as
CMS released the 2025 OPPS and ASC Final Rule last Friday. The 1,734 page document contains a number of important changes including: 2.9% payment increase for eligible hospitals New conditions of participation (CoPs) for obstetrical services Revisions of CoPs related to emergency readiness and discharge planning/transfer protocols Updates to the
CMS has released the 2025 Medicare Physician Fee Schedule Final Rule. The 3,088 page rule contains many significant coding and coverage provisions including: 2.83% payment decrease. The House has introduced a bill that would provide a 4.7% payment update which would eliminate the 2.83% decrease, if passed. Permanent coverage of
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
