On April 18, 2016, CMS released its proposed rule [PDF] addressing new payment rates and policies under both the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS), for fiscal year (FY) 2017.
via CMS’s Proposed IPPS and LTCH FY 2017 Rule: Key Takeaways
The most interesting exchange is at 44:00 in…
“Scope Creep” in Appeals is Dead CMS has instructed MACs and QICs to limit their review to the reason(s) the claim or line item at issue was initially denied. For redeterminations and reconsiderations of claims denied following a complex prepayment review, a complex post-payment review, or an automated post-payment review by a contractor, Limiting the scope of review on redeterminations and reconsiderations of certain claims. MLN Matters Number SE1521.
CMS should focus its billing audits less on verifying medical necessity and more on rooting out blatant fraud, the agency’s likely next secretary said Tuesday. Rep. Tom Price, R-Ga.
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