|
|
New on the Site
December 22, 2010 – Current Developments
The December Current Developments Newsletter has been posted. It includes:
- The 2011 additional documentation limits for RACs
- Contractors requesting mandatory ABNS with documents
- New G codes for annual wellness visit
- New flu vaccine codes
- Clarification on NaF-18 PET billing
- 2011 lab specimen collection and travel allowance fees
- Implementation of ACA “incentive Payment for Physician Services”
- 2011 reasonable charge update for splints, casts, and certain intraocular lenses
- Chart of Rescinded and Replaced Transmittals
- And a special article “Surviving the Government Oversight and Enforcement Activities in the Coming Year”
November 18, 2010 – Current Developments
The November Current Developments Newsletter has been posted. It includes:
- A summary of changes in the final 2011 OPPS/ASC rule, including the latest changes to physician supervision of outpatient diagnostic and therapeutic services
- A summary of relevant provisions in the Medicare Physician Fee Schedule 2011 final rule
- A table of the 2011 co-insurance and deductibles for Part A and Part B
- Implementation of postacute care transfer policy for transfers to nonparticipating hospitals and CAHs
- New requirements for coverage of therapy under the home health benefit
- Use of condition code 51 to identify outpatient diagnostic services within the three-day window unrelated to the admission
- And a special article on the cardiac defibrillator investigations, “MS-DRG 226 vs. 227: What Should Be on Your Radar?”
October 25, 2010 – Current Developments
The October Current Developments Newsletter has been posted. It includes:
- Reviews on the FY 2011 OIG Work Plan with billing risks
- CMS’ list of DRGs at high risk for medical necessity and coding errors based on the RAC demonstration project
- CMS’ new quarterly compliance newsletter on billing
- A Department of Justice investigation into cardiac defibrillator implants
- New coverage for tobacco cessation programs and changes in the coverage for FDG PET and HSCT
- The FY 2011 clotting factor
- CMS and payer reminders on signature requirements for physician orders
- And a special article on Condition Code 44
September 27, 2010 – Current Developments
The September Current Developments Newsletter has been posted. It includes:
- Important CMS clarification on billing non-diagnostic services during the three-day window
- Changes for the October OPPS and I/OCE
- Partial freeze on ICD-9-CM updates beginning in Oct. 2011
- Expanded coverage of quit smoking counseling
- Automatic denials of claims with –JW modifier discontinued
- List of transmittals implemented on Oct. 4
- And a special article on Transitioning to HIPAA Version 5010 Electronic Transaction Standards
August 19, 2010 – Current Developments
The August Current Developments Newsletter has been posted. It includes:
- Summary of policy changes in the Inpatient Prospective Payment System FY 2011 final rule, including a change in the acute care transfer policy, the three-day window, revised POA instructions, and for LTCH the two-year delay in a number of provisions mandated by the health care reform law.
- Instructions on which date on the form determines whether the claim was timely filed
- Revision to the IPF interrupted change policy
- A new occurrence code to be used by SNFs and IRFs
- First look at a comparative billing report
- And a special article on The PPACA and Its Impact on Medicare Billing and Payment
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
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:
- Three risk areas have been revised:
- One Compliance Profile has been revised:
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
|