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July 27, 2010 - Current Developments

The July Current Developments Newsletter has been posted. It includes:

• The revisions to the three-day window policy made by Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010, effective June 25
• Summary of the proposed FY 2011 Outpatient Prospective Payment System/ASC rulemaking, including changes to physician supervision requirements and partial hospitalization services
• The consolidation of the NCDs on magnetic resonance angiography and magnetic resonance imagery, which gives local contractors discretion regarding certain coverage
• Reminder to IPFs to use source of admission code D
• Availability of new ABN booklet
• Proposed rules for home health for FY 2011 and physician payment policies for 2011 and payment updates for SNFs and IPFs for FY 2011
• Plus a special article on Sanction Screening — Now an OIG High-Risk Priority

June 22, 2010 - Current Developments

The June Current Developments Newsletter has been posted. It includes:

• CMS clarification of the meaning of “immediately available” for  the purpose of physician supervision
• A summary of the July OPPS policy and the ASC payment system updates
• Clarification of Medicare policies on audiological diagnostic tests
• Two new NCDs and new codes to implement them
• Summary of PPACA revisions that affect the IPPS/LTCH proposed rule
• Proposed rule significantly revises telemedicine privileging and credentialing requirements
• A special article explaining CMS’s recent updates to the self-administered drugs and discarded drugs in the Medicare manuals.

June 10, 2010 - Revised Content

• Front-End Processes: Advanced Beneficiary Notices has been revised to reflect the use of new modifiers.

May 19, 2010 - Current Developments

The May Current Developments Newsletter has been posted. It includes:

• A summary of CMS’ proposal to extend the post-acute care transfer rule to nonparticipating hospitals and CAHs
• Release of the July OCE transmittal
• A revised definition of the term “administered” for purposes of self-administered drug determinations
• Implementation of new timely filing limits
• Addition of pulmonary rehabilitation benefit and coding/billing requirements to Medicare manuals
• Deadline (with consequences) for submitting certain data for Medicare Advantage patients
• New requirements for health care professionals and suppliers who order and furnish certain items and services
• Update to the amount in controversy for Medicare appeals
• A new bill type in October for colorectal screenings for hospital inpatients under Part B

April 21, 2010 - Current Developments

The April Current Developments Newsletter has been posted. It includes:

• A preview of the FY 2011 IPPS/LTCH proposed rule
• CMS’ new Web address
• Provisions in the health care reform legislation affecting hospitals and other providers
• Addition of an ICD-9-CM code to the list of codes for implantable cardiac defibrillator that do not require a modifier retroactive to Oct. 1, 2007
• New CMS initiative to centralize all Medicare claims data
• New Open Government initiatives by CMS — Medicare Dashboard and free data files
• New coverage and billing requirements for use of NaF-18 PET for cancer patients
• Billing for patients “in custody”
• Table of CMS transmittals rescinded and replaced in March
• Plus a special article on the Three-Day Window Rule, which is once again an area for auditor review

March 29, 2010 - Current Developments

The March Current Developments Newsletter has been posted. It includes:

• A summary of the April OPPS and I/OCE transmittals
• New RAC Q&A distinguishing the discussion period from the rebuttal and determination process
• New coverage and billing requirements for HIV screening tests
• Coding and billing instructions for drug screening lab codes 80100 and 80101
• Revival of the therapy cap exceptions process
• Change in reporting of occurrence span codes for beneficiaries in extended stays in LTCHs, IPFs, and IRFs
• Table of CMS transmittals rescinded and replaced in March
• Table of CMS transmittals to be implemented in April
• A list of the new and revised risk areas on the Web site
• Plus a special article on the new ABN modifiers that take effect on April 1

March 10, 2010 - New and Revised Content

• Four new risk areas have been added:
  • Central Processes: Never Events
  • Special High-Risk Area: Physician Supervision of Outpatient Diagnostic And Therapeutic Services
  • Special High-Risk Area: Long-Term Care Hospitals
  • Special High-Risk Area: Diagnostic X-Rays in the Emergency Room
• Three risk areas have been revised:
  • Special High-Risk Area: Billing for Inpatient Hospital Services with a link to the DRGs the RACs are reviewing
  • Special High-Risk Area: Billing for OPPS Hospital Outpatient Services with 2010 policy changes and a discussion of modifiers
  • Special High-Risk Area: Implantable Medical Devices with updated links
• One Compliance Profile has been revised:
  • Government Enforcement Initiatives to reflect current initiatives and enforcement structure

February 22, 2010 - Current Developments

The February Current Developments Newsletter has been posted. It includes:

• RACs add more DRGs for validation
• The release of PEPPER data
• The rescission of the policy on date of service and place of service reporting for the interpretation of diagnostic tests
• National coverage determination for OIVIT
• Billing a healthy control group in a clinical trial
• New data reporting for ESRD facilities
• New billing rules for hospices
• Plus a special article on DRG Validation: Staying One Step Ahead of the RACs