New on the Site

December 30, 2008 - Current Developments

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

• Revisions to the instructions for Form CMS-2552-96, Hospital and Health Care Complex Cost Report
• Transmittal 418, which sets out the conditions for the exception to the three-year moratorium on new long-term care hospitals or increase in the number of LTCH beds
• Updated list of CARCs and RARCs
• New national coverage determinations
• Furnishing fees for the clotting factor and the original site facility fee for telehealth services
• Changes to the laboratory NCD edit module
• Notice of collection of overpayments from home health agencies
  Plus
• Article on recent revisions to Medical Records and Utilization Review Conditions of Participation and
• The List of CMS Transmittals, effective in December 2008 and January 2009

December 5, 2008 - New Content Added

Two new risk areas have been added to the site under Special High-Risk Areas:

• Drugs, Biologicals, and Radiopharmaceuticals
• Critical Access Hospitals

November 24, 2008 - Current Developments

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

• A summary of the 2009 Outpatient Prospective Payment System final rule
• New J code for hemophilia patients with delayed submission
• New ASC payment indicators
• New C code for implanted prosthetic devices where patient has no Part A coverage
• MIPPA revisions to the initial preventative physical examination
• Clarification for billing assistants-at-surgery in a Method II CAH
• Revised Medicaid definition of outpatient services
• A MLN special edition article on how to transition from an FI/carrier to an A/B MAC
• Plus a special article on IRF compliance with the Medicare transfer policy

October 27, 2008 - Current Developments

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

• CMS Press Release Regarding Increased Fraud and Abuse Efforts
• Announcement of the National RACs and Implementation Plans
• Publication of the Medically Unlikely Edits
• Summary of the October OPPS and ASC Updates
• Release of OIG Supplemental Compliance Guidance for Nursing Facilities
• Notice of Claims Hold for DRG 999 due to HAC logic problems
• Transmittal Summarizing the Payment and Policy Changes for the IPPS and the IPF PPS
• A Table of the FY 2009 Medicare Premiums, Co-Pays, and Deductibles
• And a special article, “Hospitals, Contractors and Data Mining… What’s Next?”

October 1, 2008 - Revised Content

• Central Processes: Hospital Acquired Conditions/Present-on-Admission Reporting has been updated with the FY 2009 HACs and links to the Present-on-Admission Reporting Guidelines and the ICD-9-CM Reporting Guidelines have been updated for FY 2009.
• Central Processes: Transfers and Discharges. The link to the post-acute care DRGs has been updated to reflect the FY 2009 DRGs.
• Special Issues: Billing for Hospital Inpatient Services. The link to the ICD-9-CM guidelines has been updated for FY 2009.

September 19, 2008 - Current Developments

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

• A summary of the I/OCE that becomes operational Oct. 6
• Notice of an update to the Financial Management manual with the new Medicare process for recouping overpayments
• Billing and claims processing information on the new NCD on artificial hearts
• Notice of an extension of the hold on OPPS claims with code Q0091 (pap smear screening)
• Results of a Trailblazer audit on problems reporting unlisted CPT codes
• Quarterly table on CMS actions that will be implemented Oct. 6, 2008

September 15, 2008 - New Content Added

• Front-End Processes: Medicare Secondary Payer
• Central Processes: Length of Stay Issues
• Back-End Processes: Bad Debt
• Compliance Profiles: Government Enforcement and Initiatives

August 21, 2008 - Current Developments

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

• A summary of the final Inpatient Prospective Payment System rule for FY 2009 CMS’ announcement regarding adoption of ICD-10
• A comparison of claims review processes used by different contractors
• CMS’ explanation of the importance of correct completion of the Medicare cost reports
• Announcement of the QIOs for the 9th Scope of Work

August 1, 2008 - Current Developments

The July Current Developments Newsletter has been posted.

July 7, 2008 - Current Developments

The June Current Developments Newsletter has been posted.

July 2, 2008 - Site Launched

Welcome to www.MedicareRiskAreas.com, packed with valuable how-to tools (checklists, worksheets, policies and procedures) you need to tackle high-risk Medicare billing challenges.