CMS released Special Edition MLN Matters ® Article SE1325 to clarify split billing for certain institutional encounters that span the ICD-10 implementation date of October 1, 2014.
CMS corrected edit 84, added five APCs, deleted two APCs, and changed the description of another as part of the April updates to the I/OCE. Dave Fee, MBA, reviews the most significant changes CMS implemented
More and more entities are auditing healthcare claims-Recovery Auditors, Medicare Integrity Contractors, MACs, FIs, commercial payers, and on and on. Andrea Clark, RHIA, CCS, CPC-H, CEO, Debbie Mackaman, RHIA, CHCO, and Peggy Stilley, CPC, CPMA, CPC-I, COBGC, ACS-OB , explain how coders and their organizations can benefit from internal audits.
CMS added numerous device/procedure edits as part of the April update to the Integrated Outpatient Code Editor . To avoid triggering the edits, coders must report particular procedure codes and device codes together on the claim form.
On March 13, CMS issued a notice of ruling that establishes a policy that revises the current policy on Part B billing following the denial of a Part A inpatient hospital claim that a Medicare review contractor deemed to be not reasonable or necessary. The revisions are intended as an interim measure until CMS can finalize an official policy to address the issues raised by the Administrative Law Judge and Medicare Appeals Council decisions going forward.
CMS is currently updating its ICD-10 implementation guides for practices, small hospitals, and payers. The agency has already posted the updated guide for small and medium practices .
CMS is making a significant change to the Medically Unlikely Edits by changing the edits from line item edits to date of service edits. The change will become effective April 1.
CMS rescinded Transmittal 2607 and replaced it with Transmittal 2636 to update the add-on code edit file to include a change in the list of primary codes for CPT add-on code 90785 (interactive complexity).
On January 9, the American Medical Association sent out a notification of errata in the 2014 CPT ® Manual . The AMA followed with a January 16 correction saying the errata file is for the 2013 CPT Manual .
Coding for stent placement procedures will look very different in 2013. The American Medical Association deleted the two CPT ® codes used to report nondrug-eluting intracoronary stent placement procedures.