New on the Site

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

January 28, 2010 - Current Developments

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

• The revival of PEPPER
• Update on approved RAC issues
• Billing instructions for new kidney disease education
• Updates on telehealth billing and the telehealth site facility fee
• Plus a special article on Billing for Outpatient Therapy Services in 2010, which highlights a shift in policy for physician supervision

December 18, 2009 - Current Developments

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

• A summary of the OPPS transmittal and I/OCE for January, which implement many of the changes from the final rule
• Revisions to the Medicare Benefit Policy Manual to reflect the revised physician supervision provisions
• A reminder that Medicare will no longer accept the CPT consulting codes
• A notice from CMS that many providers are incorrectly reporting the wrong surgery modifiers and from the CERT contractor of billing for non-covered uses of dual chamber pacemakers
• An NCD on Medicare coverage for FDG PET when used with patients with cervical cancer
• And a special article, A Look at the RACs, Past, Present, and Future

November 23, 2009 - Current Developments

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

• Summary of the policy changes in the final OPPS rule for 2010, including physician supervision and coverage of cardiac, intensive cardiac, and pulmonary rehabilitation programs
• 2010 coinsurance and deductibles
• New modifier for voluntary ABNs
• Separate claims for inpatients with both covered and non-covered services
• Phase-out of the mental health limitation over a five-year period
• and a special article, “Protect Yourself: Know How to Bill Medicare for H1N1 and Seasonal Flu Vaccines to Prevent Revenue Loss”

October 16, 2009 - Current Developments

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

• Highlights of the HHS OIG Work Plan for FY 2010
• New audit areas for review based on four OIG reports
• Important replacement transmittals for reporting surgical “never events” and FDG PET for solid tumors and myeloma
• The Region A list of RAC issues
• The amount in controversy thresholds for 2010
• The final rule explaining how CMS will comply with the prohibition on recouping overpayments from a provider seeking reconsideration
• And a special article on "Billing for Surgical ‘Never’ Events"

September 17, 2009 - Current Developments

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

• Summaries of the quarterly OPPS/ASC and I/OCE updates, eff. Oct. 1, which include new codes for the H1N1 vaccine
• Updated lists of the RAC-approved issues
• Announcement of the proposed PPS for ESRD facilities
• Revisions to both the Medicare Benefit and Claims Processing Manuals to incorporate the rules for billing for services rendered to individuals in custody
• Documentation problems found in a probe review of two common drugs
• A list of transmittals that will be implemented on Oct. 5
• and a special article, “Reporting E-Codes for Surgical ‘Never’ Events,” which are required Oct. 1

August 20, 2009 - Current Developments

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

• A summary of the final IPPS/LTCH rule for FY 2010
• The first round of RAC review areas
• Posting of revised Medicare cost report
• New point of origin codes
• CAH policy changes
• New billing for ambulance trips
• Release of HITECH breach notification rule
• And a special article, "Returning Improper Payments"

July 28, 2009 - Current Developments

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

• A summary of the OPPS proposed rule for 2010
• Major changes to coverage of FDG PET
• Correction to the July OPPS update
• New NCD for sleep testing devices
• MLN Matters article on billing Part B or Part D for aprepitant
• And a special article, “New Legal Exposure When You Fail to Repay Overpayments,” which discusses changes to the False Claims Act by the Fraud Enforcement and Recovery Act

June 25, 2009 - New and Revised Content

• Two new risk areas have been added:
  • Special High-Risk Area: Laboratories
  • Special High-Risk Area: Implantable Medical Devices
• Two risk areas have been revised:
  • Back-End Processes: Overpayments and Credit Balances has been revised with material on the RACs.
  • Special High-Risk Area: Blood and Blood Products in Drugs and Biologicals to reflect the addition of a revenue code

June 18, 2009 - Current Developments

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

• Summary of the July update to the OPPS
• Status of the RAC program rollout
• Information on the redesigned PS&R
• Three NCDs and payment consequences for “wrong” surgeries
• Posting of the FY 2010 ICD-9-CM
• Revised MS LTC DRG weights
• List of CMS transmittals to be implemented during the summer
• And a Special Article on Version 5010 of the HIPAA Electronic Transaction Standards

May 21, 2009 - Current Developments

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

• A summary of the proposed Inpatient PPS for FY 2010
• The July I/OCE changes
• A new patient status code for court/law enforcement
• Recoupment of overpayments for MS-DRG 956
• Claims for managed care clinical trial patients
• July 2009 changes to the laboratory NCDs
• And a special article “Incident-to Supervision of Outpatient Therapeutic Services: Are You in Compliance?”

April 21, 2009 - Current Developments

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

• What to expect from the RACs as they begin their reviews
• A summary of the ARRA provisions that affect teaching hospitals and long-term care hospitals
• Coding and billing for clinical trials
• Expanded coverage for use of PET scans with cancer patients
• Medicare payment for maintenance and servicing of oxygen concentrators and certain other equipment
• Clarified instruction for SNF billing of exhaust benefits
• And a special article, “When Does CMS’ Anti-Markup Rule Apply?”

March 18, 2009 - Current Developments

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

• A summary of the April updates to the Outpatient Prospective Payment System, the Integrated Outpatient Code Editor, and the ASC Payment System
• The findings of an OIG audit of postacute care transfer billing...before and after CMS activated the edit to identify incorrect claims
• Two coverage decisions affecting sleep apnea and bariatric surgery
• Billing instructions for purchased diagnostic and lab tests performed by a provider outside the billing jurisdiction
• Availability of a chart on billing noncovered charges and use of the new ABN
• And a special article on the permanent RAC program

February 20, 2009 - Current Developments

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

• A reminder of the required use of the new ABN that replaces ABN-G and ABN-L as of March 1
• A summary of the billing and payment policies for co-surgeons at Method II critical access hospitals
• Clarification of  the date of service for ambulance services when the beneficiary dies
• The expected launch of the Long-Term Care Hospital Special Project
• A CMS notice that reclassifies the drug code J3300 from an “N” to a “K” status
• A new reporting requirement for drugs with FDA approval but without a specific drug code
• New codes for inpatient telehealth consultations
• CMS instructions to payers to review claims with modifier –79 and those for facet joint procedures
  Plus
• A review of the criteria, documentation, and billing for observation services

February 17, 2009 - New and Revised Content

• A new risk area has been added to the site under Central Processes:Copayments and Deductibles.
• These areas have been revised:
  • Front-End Processes: Advanced Beneficiary Notices-updated to reflect new ABN required for Part B services, as of March 1, 2009
  • Front-End Processes: Inpatient-Only Procedures updated links for 2009 lists
  • Front-End Processes: Observation Services, updated with new resource links and revisions to the Extended Care and Assessment APCs for 2009
  • Special High-Risk Area: Outpatient billing—updated with status indicators for 2009 and an expanded list of risk areas