Medicare Fee-For-Service (FFS) will accept only ASC X12 Version 5010 or NCPDP Telecom D.0 electronic transactions beginning on July 1, according to a CMS June 11 Medicare Fee-For-Service Provider Partnership Program e-newsletter.
CMS has issued both a National Coverage Determination (NCD) Transmittal 143 and Medicare Claims Processing Transmittal 2473 on the coverage of extracorporeal photopheresis for the treatment of bronchiolitis obliterans syndrome (BOS) in certain circumstances under clinical research studies.
CMS released its latest MLN Medicare Quarterly Provider Compliance Newsletter in April. The newsletter features educational information for providers related to recent audit targets and findings.
Inpatient acute care hospitals could see a 2.3% increase in payment rates under the fiscal year (FY) 2013 Inpatient Prospective Payment System (IPPS) proposed rule, released April 24. The 2.3% is a net update after inflation, improvements in productivity, a statutory adjustment factor, and adjustments for hospital documentation and coding changes.
HHS’ proposed rule announcing a one-year delay of the implementation of ICD-10-CM/PCS was printed in the April 17 edition of the Federal Register . If HHS finalizes the delay, ICD-10-CM/PCS would become effective October 1, 2014.
CMS has posted a summary report from the discussion of procedure codes at the ICD-9-CM Coordination and Maintenance Committee meeting held March 5. The agenda addressed only a small number of code requests due to the implementation of the partial code freeze.
CMS released in February a fact sheet, “Global Surgery,” which contains information regarding the components of a global surgery package, including guidance about billing and payment rules for surgeries, endoscopies, and global surgical packages that are split between two or more physicians.
Special Edition MLN Matters article #SE1210 , “Recovery Auditors Findings Resulting from Medical Necessity Reviews of Renal and Urinary Tract Disorders,” outlines recovery auditor findings upon completion of medical necessity reviews. In the article, which addresses documentation and billing for inpatients, recovery auditors concluded that providers had been admitting patients even for clinical situations for which outpatient observation services would have been appropriate.
Trailblazer Health Enterprises, LLC, the Medicare administrative contractor (MAC) for Jurisdiction 4 (i.e., Colorado, New Mexico, Oklahoma, and Texas) stated in a February 21 notice that about 68% of reviewed claims billed with MS-DRG 470 (joint replacement or reattachment of lower extremity without MCC) resulted in denials. The MAC cited missing or insufficient documentation as the reason for 96% of these denials.
CMS issued Transmittal 1039 in the One-Time Notification Manual on February 3, which provides guidance on reporting claims submissions and date span requirements for 33X Type of Bill, which pertains to Home Health Agencies, containing ICD-10 codes with dates of discharge on or after October 1, 2013.
The January issue of Medicare Quarterly Provider Compliance Newsletter (volume 2, issue 2) addressed a number of recovery audit findings, including ambulance services separately payable during an inpatient hospital stay, diseases and disorders of the circulatory system, and minor surgery and other treatment billed as inpatient stay.
The Office of the Inspector General (OIG) stated in its recent publication, “Hospital Incident Reporting Systems Do Not Capture Most Patient Harm,” that a series of reports examining adverse events in hospitals shows that for the hospitals it surveyed, the incident reporting systems only tracked approximately 14% of incidents.
Coders should already be familiar with the 285 new, revised, and deleted ICD-9-CM codes that CMS finalized for fiscal year (FY) 2012. However, it’s critical that providers also examine how these changes directly affect MS-DRG assignment. Robert Gold, MD, examines a number of these changes, including MS-DRG assignment related to cardiac-specific comorbidities, autologous bone marrow transplants, excisional debridement, and thoracic aneurysm repair.
Although the New Year marked the deadline for Version 5010 compliance, CMS recently reminded providers that it will not exercise enforcement until April 1, 2012. Despite the 90-day discretionary period, CMS urged providers that they should complete the transition to Version 5010 as soon as possible. This extension will not have any effect on the implementation date for ICD-10-CM/PCS, which remains set for October 1, 2013.
