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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• Chart of Rescinded and Replaced Transmittals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

• 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