Three out of four providers have completed only 25% or less of their ICD-10-CM/PCS conversion process, according to an ICD-10 snapshot survey conducted by the Aloft Group in February. However, CMS and others are busy helping to ensure that providers and payers are ready for the transition to ICD-10-CM/PCS.
Medical necessity for cardiovascular procedures is the top overpayment issue for three out of the four Recovery Auditors in FY 2013 first quarter (October 2012–December 2012), according to the most recent release of improper payment statistics .
More than 450 healthcare organizations will participate in CMS’ Bundled Payments for Care Improvement Initiative . CMS announced the specific organizations in January, and some participants will begin receiving bundled payments as early as April. The program will be in effect for three years.
Thirty-day readmissions for heart failure, heart attack, and pneumonia occur most frequently for reasons other than the cause of the initial hospitalization, according to a study published in the January 23 issue of the Journal of the American Medical Association (JAMA).
One of AHIMA’s long-time goals is to empower HIM professionals to be heavily involved in the ICD-10 overhaul and perhaps even leading the transition in their facility.
The FY 2013 Office of Inspector General (OIG) Work Plan includes plenty of new additions that might interest inpatient hospitals. Sara Kay Wheeler, Kimberly Anderwood Hoy, JD, CPC, Monica Lenahan, CCS, and William E. Haik, MD, FCCP, CDIP, review those new additions and offer tips for dealing with OIG scrutiny.
If you’re curious about whether something you’ve heard or read about the Recovery Auditor program is true, be sure to check out new information published on the CMS Web site. The agency released a document that addresses 14 common myths about the program.
National Government Services, under contract with CMS, will host a series of listening sessions about lessons learned from the Version 5010 upgrade to prepare providers, vendors, and payers for the transition to ICD-10-CM/PCS.
In a recent CMS email to providers, the agency reminded hospitals that any department, form, template, or other information that uses ICD-9-CM codes today will need to accommodate ICD-10-CM/PCS codes as of October 1, 2014.
Providers will continue to use the same definition of inpatient status that they already know. That’s because despite CMS’ consideration of various provider comments, the agency has not establish new criteria.
Hospitals are overturning Recovery Auditor denials nearly 75% of the time, according to recent RACTrac data. That’s why the American Hospital Association adamantly supports a new proposed bill—the Medicare Audit Improvement Act of 2012 —aimed at holding Recovery Auditors accountable for inappropriate denials.
Although hospital infection rates continue to decline, Medicare payment penalties are not the cause, according to the New England Journal of Medicine article titled Effect of Nonpayment for Preventable Infections in U.S. Hospitals .
CMS has published two ICD-10-related Special Edition Medlearn Matters articles that may be of interest to providers and serve as tools to assist with implementation.
The OIG estimates that Medicare Administrative Contractors paid $8.4 million in overpayments to inpatient rehabilitation facilities (IRFs) because IRF and Medicare payment controls did not adequately identify late submissions of patient assessment instruments.
Providers may find themselves with a completely new definition of the term inpatient if CMS follows through with its intent to clarify this ever-confusing patient status, as explained in the 2013 OPPS proposed rule published July 30. The agency solicits input from providers on pp. 45155-45157 of the rule and suggests that it may implement fairly significant changes going forward.
Coders play a crucial role in ensuring compliance, and the FY 2013 IPPS final rule , released August 1, gives them many reasons to showcase their skills. William E. Haik, MD, FCCP, CDIP, and Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, detail the changes and how coders can take charge of them.
Providers are urging CMS to reconsider its current ICD-10 education and outreach strategy to ensure that providers are prepared to implement the new code set. CMS published and addressed specific provider comments in a final rule released August 25 that confirms the delay of ICD-10 to October 1, 2014.
HHS will delay implementation of ICD-10 by one year, from October 1, 2013, to October 1, 2014. HHS announced the delay as part of the Administrative Simplification: Adoption of a Standard for a Unique Health Plan Identifier; Addition to the National Provider Identifier Requirements; and a Change to the Compliance Date for the International Classification of Diseases, 10thEdition (ICD-10-CM and ICD-10-PCS) Medical Data Code Sets final rule released August 24.
CMS officially announced the Recovery Auditor prepayment review demonstration in November 2011, but then in January 2012 decided to delay the program by three months. Since then—despite rumors that the program could be coming soon —the official start date has been unknown to the public. This changed however, when CMS announced Friday, August 3, that Recovery Auditor prepayment reviews will begin August 27.
CMS released its latest MLN Quarterly Provider Compliance Newsletter, volume 2, issue 4 in July. The newsletter addresses common billing and coding errors, with the latest issue addressing frequently cited Recovery Auditors and Comprehensive Error Rate Testing (CERT) findings.
