NAMDRC

The National Association for Medical Direction of Respiratory Care

The Washington Watchline

The HHS Office of Inspector General is Auditing Critical Care Services

In 2019, The Office of Inspector General (OIG) of Health and Human Services, will be continuing its efforts to identify errors in provider billing in the Medicare program. The great majority of the OIG’s work is focused on Medicare and Medicaid programs with roughly three quarters of its total funding committed to these two programs. This year, critical care services billed to Medicare, American Medical Association Current Procedural Terminology (AMA CPT) codes 99291 and 99292, will be audited by the OIG.

Durable Medical Equipment Issues for 2019

On November 1, 2018 the Centers for Medicare & Medicaid Services (CMS) released the final rule that will apply to durable medical equipment (DME) coverage and payment for 2019. This rule finalized modifications to Medicare Part B reimbursement policies for home oxygen therapy, proposed in July, as well as the addition of a HCPCS code and payment for a new ventilator class, the “multi-function ventilator”.

Smoothing the Path for Medical Device Innovation

On October 3, 2018 the Centers for Medicare & Medicaid Services (CMS) proudly announced:   “CMS Accelerates Innovation and Promotes Patient Access to Medical Technology”. This announcement was in reference to revisions to Medicare’s Program Integrity Manual Chapter 13 that were made to increase transparency in the Local Coverage Determination (LCD) process.

CMS Confirms the Changes to Reimbursement for Office Visits

On November 1st, the Centers for Medicare and Medicaid Services (CMS) issued the final rule on the 2019 Physician Fee Schedule (PFS) and Quality Payment Program (QPP). The proposed rule, issued in July, caught the attention of the medical community with the CMS declaration that the American Medical Association Current Procedural Terminology (AMA CPT) code set was outdated. As a first step to address this concern, CMS proposed significant changes to payment rates and documentation requirements for the outpatient evaluation and management (E/M) codes.

CMS Aligns Physician and Hospital Financial Incentives

The Centers for Medicare and Medicaid Services (CMS) is implementing regulations in the proposed 2019 Physician Fee Schedule and the finalized 2019 Inpatient Prospective Payment System that will increase the interdependence between hospital administration and physician practice.

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