In today's healthcare environment, it's important to find innovative ways to save on costs while improving patient outcomes and maximizing profits. One of the most compelling areas for consideration is to merge inpatient and outpatient wound care programs.
Medicare and other providers have increased scrutiny of modifier 25, and the Office of the Inspector General (OIG) has identified it as a potential area of overuse or misuse, thereby increasing the possibility of audits. Here's what you need to know.
Meet Margaret Mack, the woman behind the curtain! As our Luvo Liaison for the Atlantic Region, she helps our partners and patients get the most out of their wound care and hyperbaric oxygen therapy programs.
Last week, we discussed the “Site-Neutral Rule,” which would reduce Evaluation and Management charges for off-campus outpatient programs, including wound care and hyperbaric medicine centers. This week, 38 Hospitals sued Health and Human Services (HHS), challenging the rule. The lawsuit alleges that HHS Secretary Alex Azar exceeded his authority when this rule was implemented January 1, 2019.
In the final rule released in 2018 for 2019, CMS decided to reduce the E&M Level reimbursement for all off-campus departments of the hospital, including exempted centers. This reduction only affects CPT code G0463. If you have an off-campus provider-based department of the hospital, you will now be reimbursed 70% of the OPPS rate for 2019 with further reduction down to 40% in 2020.
The OIG released the results of a MAC audit report on Hyperbaric Oxygen Therapy (HBOT) services. Based on the sample charts, they estimated there were over $39 million in HBOT overpayments for the sample year alone in this jurisdiction.