CMS announced a new incentive program designed to reduce complications from joint replacement surgery. The new proposed Comprehensive Care for Joint Replacement will require bundling of reimbursement for hip and knee surgeries, with profits tied closely to costs and quality metrics.
Coders will find 50 new codes in ICD-10-PCS for 2016, according to the summary of changes posted by CMS . CMS also introduced a new section for ICD-10-PCS, X (new technology). In addition, guidelines B3.11b, B3.4a, B3.2b, and B4.1b were revised in response to public comment.
CMS provided plenty of proposed refinements to quality measures in the 2016 IPPS proposed rule, but did not suggest any changes to the 2-midnight rule. Kimberly A.H. Baker, JD, CPC, James S. Kennedy, MD, CCS, CDIP, and Shannon Newell, RHIA, CCS, highlight the most significant proposed changes.
An automated Recovery Auditor review of discharge status codes identified improper payments, according to the Medicare Quarterly Compliance Newsletter . However, CMS did not report the prevalence of the errors.
The 2014 ICD-10 implementation delay negatively impacted ICD-10 preparations, according to the Workgroup for Electronic Data Interchange (WEDI) February 2015 readiness survey .
CMS Transmittal 3217 , effective April 1, will allow inpatient-only procedures to be included on inpatient claims, similar to other outpatient services included in the three-day window.
Three university hospitals saw a doubling of Recovery Auditor audit activity from 2010–2011 to 2012–2013, and a nearly three-fold increase in overpayment determinations, according to a new study in the Journal of Hospital Medicine.
CMS is adequately preparing to implement ICD-10 October 1, according to a new Government Accountability Office (GAO) report detailing CMS’ transition efforts.
Physician documentation for the use of osteogenic stimulators for nonunion of fractures is often insufficient for Medicare coverage, according to Comprehensive Error Rate Testing (CERT) results .
The District of Columbia federal district court dismissed a lawsuit December 18, 2014, filed by the American Hospital Association (AHA) against HHS for excessive and inappropriate Recovery Auditor denials, according to AHA News. The AHA announced that it may appeal the court’s decision.
CMS Transmittal 547 changes the audit timeframe for complex reviews from 60 to 30 days for some MAC and Recovery Auditor reviews. The change could significantly affect the volume and timeliness of complex reviews for providers. The transmittal becomes effective February 24, 2015.
Beginning January 1, 2015, physicians will no longer need to provide certification for an inpatient admission unless the admission is expected to last for 20 days or longer or the case is an outlier.
The four Cooperating Parties released the 2015 ICD-10-CM guidelines and, in the process, deleted a guideline that affects inpatient coding. Both the Centers for Disease Control and Prevention and CMS posted the new guidelines on their websites.
