Compliance Question of the Week – General

What is the Medicare Open Payments program?

I understand that the PQRS is being phased out. Is that correct and, if so, when will that occur?

Can modifier 59 be reported with E&M codes?

What’s the difference between the Outpatient Code Editor (OCE) edits and the National Correct Coding Initiative (NCCI) procedure to procedure (PTP) edits?

On the Medicare outpatient observation notice (MOON), are hospitals and CAHs permitted to use pre-populated check boxes for the free-text field (“You’re a hospital outpatient receiving observation services. You are not an inpatient because:”)?

One of our staff has identified a Medicare overpayment. What should we do?

How often does CMS update the NCCI tables?

What codes would be assigned for advance care planning (ACP)?

Is there an appeal process for units of service denied based on medically unlikely edits (MUEs)?

I am trying to understand the term “consolidated billing” as it applies to skilled nursing facilities (SNFs). Can you provide some information?

What will be the payment increase or decrease for the next year of the IPPS?

In terms of Medicare billing, what does it mean when a CPT® code descriptor includes the term “separate procedure”?