“This claim was denied after review and it was determined that the documentation did not support the need for an inpatient level of care.”
NHIC Inc., the Medicare Administrative Contractor (MAC) for jurisdiction 14 (which includes Maine, Massachusetts, New Hampshire, Rhode Island...Read More »
CMS’ three-day rule defines certain preadmission services as inpatient operating costs, meaning they are bundled and billed as part of the inpatient claim and payment is made as part of the applicable DRG payment for the case. This sounds simple, and there had been very little new guidance for...Read More »
The ICD-9-CM guidelines state that it’s unusual for two or more diagnoses to meet the definition of principal diagnosis. However, coders know this isn’t exactly true, as the scenario tends to occur frequently.
Pneumonia and heart failure is a common combination with which patients...Read More »
CMS projects that payment rates to general acute care hospitals will increase by 2.3% in fiscal year (FY) 2013, according to a March 24 release regarding the Inpatient Prospective Payment System (IPPS) proposed rule. CMS released the IPPS proposed rule yesterday.
As I’m sure most of you are aware, The Department of Health and Human Services (HHS) has proposed a one-year delay of ICD-10-CM and ICD-10-PCS. You can read the complete release here http://www.gpo.gov/fdsys/pkg/FR-2012-04-17...Read More »
