Mikki Fazzio, RHIT, CCS

Healthcare organizations risk losing more than $200 billion annually to denied claims. Of this loss, medical necessity denials account for $2.5 billion. In response, providers need a mid-revenue management solution that includes healthcare claims management, such as medical necessity edits (MNEs), and ensures claims fall within acceptable standards. Accounting for MNEs for a broad range of commercial insurances in addition to Medicare and state Medicaid MNEs, the Vitalware® by Health Catalyst medical necessity tool offers a comprehensive, timely, and accurate solution to help organizations avoid lost compensation and revenue delays.

Changes to the ICD-10-PCS codes for the fiscal year 2023 include 64 deleted codes, 331 new procedure codes, and no revisions. The updates, which take effect on October 1, 2022, bring the total of ICD-10-PCS codes to 78,496. Health system leaders can prepare for the new round of procedure codes by taking inventory of the areas and interventions impacted, including the following:

1. Medical and surgical.
2. Administrative.
3. Extracorporeal or systemic assistance and performance.
4. New technology.

CMS将在2023 ICD-10-PCS代码本中发布这些代码，但它们现在可以在健康催化剂产品的Vitalware®中查看。世界杯葡萄牙vs加纳即时走地

Healthcare technology continues to evolve, often significantly impacting the delivery of care and therefore reporting and coverage for providers. In response, the American Medical Association (AMA) has developed CPT Category III codes to report emerging technology, services, procedures, and service paradigms. New Category III codes for 2022 take effect on July 1. While these codes don’t guarantee coverage for a particular procedure, providers must assign them as appropriate for accurate data collection. The AMA will publish the new codes in the 2023 CPT codebook, but healthcare leaders can access them now within Vitalware® by Health Catalyst products.

The Centers for Medicare and Medicaid Services (CMS) has long published a list of procedures that—for safety reasons—providers could only perform and receive reimbursement for in the hospital inpatient setting (the Inpatient-Only (IPO) list). However, in 2020, CMS announced a plan to phaseout the IPO list, which would have removed the inpatient requirement for certain services. More recently, a CMS ruling reversed the 2020 phaseout, thereby reinstating the IPO list. Many stakeholders consider the reversal of the phaseout a benefit to patients, providers, and hospitals in terms of improved patient safety, increased reimbursement, reduced physician burden, and more.

Most providers aim to protect patients from unexpected and unmanageable medical bills. But on January 1, 2022, this responsibility becomes law under the No Surprises Act. The upcoming legislation targets surprise medical bills, which occur when a patient unknowingly receives care from out-of-network providers and is subject to higher charges than for in-network care. These unexpected bills degrade the patient experience and decrease the likelihood of payment for care. Surprise bills may also be more common than many consumers and providers realize—according to the Centers for Medicare and Medicaid Services, in 2016, 42.8 percent of emergency room bills resulted in out-of-network charges. With greater price transparency, the No Surprises Act seeks to protect patients but also impacts providers and facilities, ambulance services, and more, who must comply to receive timely payment and avoid penalties.

Healthcare organizations continue to suffer from COVID-19-driven economic setbacks. As a result, getting paid appropriately for services is more important than ever. The federal government provides programs to support healthcare financial recovery, but relief payment isn’t automatic or guaranteed. To qualify for the COVID-19 add-on payment, organizations must stay up to date with the rules and regulations around coding and billing for COVID-19, as compliance with these changes may affect reimbursement.

The following three requirements will help health systems ensure add-on payments for patients diagnosed with COVID-19:

1. Include a copy of the positive COVID-19 laboratory result in the medical record.
2. Create internal polices for COVID-19 results from more than 14 days before admission.
3. Document and appropriately code the COVID-19 diagnosis.