As providers prepare for the thousands of new codes and updated guidelines to be implemented October 1, the ICD-10 Coordination and Maintenance Committee recently met to discuss the next batch of updates to be implemented October 1, 2017.
After an almost five-month deferment, the Beneficiary and Family Centered Care Quality Improvement Organizations resumed initial patient status reviews of short stays in acute care inpatient hospitals, long-term care hospitals, and inpatient psychiatric facilities, CMS announced on their website.
CMS recently released a fact sheet regarding the coding and billing of advance care planning services, following the release of a frequently asked questions document in July on the topic.
A study conducted by Johns Hopkins Armstrong Institute for Patient Safety and Quality finds that common measures used by government agencies and public rankings to rate the safety of hospitals, such as the Agency for Healthcare Research and Quality’s patient safety indicators, and hospital-acquired conditions, do not accurately capture the quality of care provided.
CMS is proposing to replace status indicator E (services not paid, non-allowed item or service) with two more specific status indicators in the 2017 OPPS proposed rule. The agency proposes status indicator E1 for items and services not covered by Medicare and E2 for items and services for which pricing information or claims data are not available.
CMS released the fiscal year 2017 IPPS final rule August 2. ICD-10-CM/PCS code changes and the addition of the Medicare Outpatient Observation Notice had a starring role in the final rule.
CMS recently released a short guide aimed at teaching healthcare professionals how to use the Medicare National Correct Coding Initiative tools and the differences between types of edits.
The American Hospital Association recently released its response to CMS’ FY 2017 IPPS proposed rule. The letter, which was sent to CMS’ acting administrator Andrew Slavitt, was presented on behalf of approximately 5,000 AHA member facilities and 43,000 individual members.
CMS’ 2017 OPPS and Medicare Physician Fee Schedule (MPFS) proposed rules, released July 6 and 7, respectively, introduce policies that focus on improving payment accuracy across sites and for professionals in primary care, care management, and patient-centered services.
CMS recently released the 2017 ICD-10-PCS code updates and guidelines, which include changes to certain root operations. Of the updates, the most notable modifications are the addition of root operation Perfusion, and edits to the current definitions of Control and Creation.
CMS issued a final rule last week to revamp the way it pays for tests under the Clinical Laboratory Fee Schedule, though the agency has pushed the start date back a year and worked to ease administrative burden based on public comments.
Providers should already be aware they will have to report more specific ICD-10-CM codes when CMS ends its grace period for physicians later this year, but the agency will also be excluding certain unspecified codes from reporting in 2017.
CMS recently released its seventh maintenance update for National Coverage Determinations to incorporate ICD-10 and other coding updates, which may require providers to contact Medicare Administrative Contractors regarding previously submitted claims.
The American Health Information Management Association has officially responded to proposed ICD-10-CM/PCS codes that were presented at the ICD-10 Coordination and Maintenance Committee meeting held in March by CMS.
Sepsis isn’t the only clinical condition with an updated definition that could impact coding and documentation. A task force of the National Pressure Ulcer Advisory Panel recently changed terminology related to pressure ulcers that includes new terms that are not yet part of ICD-10-CM.
CMS issued the fiscal year 2017 IPPS proposed rule on April 18, and has proposed changes to the Medicare Code Editor software program based on numerous provider requests.
CMS released a list of the thousands of new ICD-10-CM and ICD-10-PCS codes set to be activated October 1, 2016, as part of the 2017 IPPS proposed rule.
CMS issued the fiscal year 2017 IPPS proposed rule yesterday with updates to several quality initiatives and a reversal of the agency’s 0.2% payment reduction instituted along with the 2-midnight rule in the FY 2014 rule.
E/M services resulted in a projected $4.5 billion in improper Medicare payments in 2014, according to the April 2016 Medicare Quarterly Compliance Newsletter, accounting for 9.3% of the overall Medicare fee-for-service improper payment rate.
An infographic newly released by CMS guides healthcare providers toward better assessing, addressing, and maintaining progress since ICD-10 implementation. Identifying key performance indicators and creating baselines for KPI analysis are important steps in tracking progress, says CMS.
The Centers for Disease Control and Prevention released new guidance last week with updated clinical recommendations for patients exposed to the Zika virus and also announced a registry for pregnant women infected with the virus.
On March 9 and 10, CMS held the ICD-10 Coordination and Maintenance Committee meeting to discuss approving changes, additions, and other modifications to the ICD-10 code set.
According to the American Hospital Association’s 2015 fourth quarter RACTrac survey, the most commonly cited reason for a Recovery Auditor’s complex claim denial is due to an inpatient coding error.
Implementation of electronic health record (EHR) systems can reduce queries and create more standardized documentation for providers, but now, according to a study published by the Journal of Patient Safety , EHRs are also linked to fewer in-hospital patient complications.
The mosquito-borne illness known as Zika virus still has unanswered questions surrounding the illness its self, but thanks to the Centers for Disease Control and Prevention, an official ICD-10-CM diagnosis code has been assigned to the virus.
CMS recently announced a delay in the anticipated system release of outpatient and inpatient quality reporting data due to the relocation of the Health Care Quality Information System Data Center responsible for the Hospital Quality Reporting programs.
CMS is reporting that the Quality Improvement and Evaluation System (QIES) will be down for five days in March due to extended systems maintenance. The QIES will be unavailable starting at 8 p.m. Eastern on March 16, and returning March 21 at 11:59 p.m., according to CMS.
As the healthcare industry acclimates to using ICD-10, coders can rest assured it will still be several years until ICD-11 becomes a reality. Originally pegged for a 2015 release to the World Health Assembly, the World Health Organization (WHO) has quietly pushed ICD-11’s debut to 2018.
A decrease in staff productivity has been the top challenge for providers after ICD-10 was implemented, but relatively few organizations have seen a significant decrease, according to a recent survey from Navicure.
The improper payment rate for oxygen equipment and supplies to the Medicare program was 62.1% with projected improper payments of approximately $952 million during the 2014 reporting period, according to a Comprehensive Error Rate Testing (CERT) program study detailed in the January 2016 issue of the Medicare Quarterly Compliance Newsletter.
If two ICD-10-CM diagnoses are not related to each other, but exist at the same time, they may be reported together despite an Excludes1 note, according to a recent release from the Centers for Disease Control and Prevention. The coding advice has been approved by the four Cooperating Parties—the American Health Information Management Association, the American Hospital Association, CMS, and the National Center for Health Statistics.
While providers are still awaiting further guidance on the four modifiers CMS introduced as subsets of modifier -59 (distinct procedural service), the latest NCCI Manual does include clarification for certain scenarios involving the modifier.
Outpatient coding and billing errors lead to more than half of all automated denials by Recovery Auditors, according to the latest RACTrac survey from the American Hospital Association.
A recent court ruling determined that CMS had to explain its calculation for a negative 0.2% reduction in inpatient payment rates as a result of implementing the 2-midnight rule. The court also said that providers should have an opportunity to comment on the calculation.
CMS recently released an ICD-10-CM resource for specialties and specific conditions and services that collects varied educational tools, including webcasts, case studies, and clinical concept guides.
ICD-10 implementation has gone smoothly for approximately 80% of attendees who responded to a survey during a recent webcast from audit, tax, and advisory firm KPMG.
Jugna Shah, MPH, and Valerie A. Rinkle, MPA, review newpolicies and regulations from CMS in the 2016 OPPS final rule, including a new comprehensive APC for observation.
CMS and Medicare Administrative Contractors are aware of certain issues regarding National Coverage Determinations and Local Coverage Determinations related to ICD-10 and working to resolve them as soon as possible, according to CMS.
CMS does not require ordering providers to rewrite orders prior to ICD-10 implementation with appropriate diagnosis codes for laboratory, radiology, and other services, including durable medical equipment, prosthetics, orthotics, and supplies, according to a new FAQ.
CMS introduced several new HCPCS codes and added comprehensive APCs (C-APC), including one for observation, in the 2016 OPPS final rule, released October 30.
CMS finalized its proposals regarding the 2-midnight rule in the 2016 OPPS final rule, including moving responsibility for enforcement and education of the rule from Recovery Auditors to Quality Improvement Organizations (QIO). This latter change occurred October 1, 2015.
Insufficient documentation is the leading cause of improper payments for claims involving referring providers, according to a Comprehensive Error Rate Testing (CERT) program study detailed in the October 2015 Medicare Quarterly Compliance Newsletter .
CMS released a new resource to help providers find the right contacts for ICD-10 questions involving Medicare and Medicaid claims. The resource guide and contact list provides phone numbers or email addresses for Medicare Administrative Contractors and state Medicaid offices for each state and U.S. territory.
Recovery Auditors have identified numerous potential duplicate claims from Medicare Part B providers, according to the October 2015 Medicare Quarterly Compliance Newsletter . These claims are send to MACs for further action, which could include overpayment recovery.
The 2016 IPPS final rule includes many new claims-based measures for 2018 and 2019 payment determination. Shannon Newell, RHIA, CCS, provides an overview of those measures and additional changes to theHospital Value-Based Purchasing and Hospital-Acquired Conditions Reduction programs.
In the first three years after implementation, incentives and penalties tied to the Hospital Value-Based Purchasing (HVBP) Program had a minimal effect on Medicare, while doing little to improve quality trends, according to a recent Government Accountability Office (GAO) report.
Sometimes people do their homework with setting up a new system, and sometimes they don't. Sometimes they do their homework, but not enough of it, and billions of dollars of wasteful spending occurs that could be avoided. But "they" won't listen.
Most improper payments for diagnostic nasal endoscopies reviewed during a Comprehensive Error Rate Testing (CERT) special study occurred due to insufficient documentation, according to the latest Medicare Quarterly Compliance Newsletter .
Providers need to report all services from October 1 forward with ICD-10 codes, but many will likely face scenarios with patients whose dates of service begin prior to October 1 and end after implementation. CMS has released special guidance to clarify how those instances would be billed with each bill type in MLN Matters ® SE1325 .
A Recovery Auditor review of claims from September 25, 2012, to August 30, 2013, found providers billing hydration therapy with diagnosis codes not considered reasonable and medically necessary, according to the July 2015 Medicare Quarterly Compliance Newsletter .
The 2016 IPPS final rule continues CMS’ plan to shift Medicare payments from volume to quality. Shannon Newell, RHIA, CCS, and James S. Kennedy, MD, CCS, CDIP, analyze the rule and the impact it could have on providers.
CMS has released a transcript and recording of its August 27 MLN Connects Call featuring ICD-10 coding guidance and the results of CMS’ final round of end-to-end testing.
OPPS costs rose approximately $1 billion more than expected in 2014 due to a CMS overestimation of the impact of laboratory packaging changes, according to the 2016 OPPS proposed rule. As a result, CMS proposes a 2% reduction to the 2016 conversion factor. CMS also proposes to expand laboratory packaging from date of service to the claim level.
The 2016 OPPS proposed rule released July 2 is deceptively short, but packs a punch. CMS is proposing the most massive APC reconfiguration and consolidation of APC groups since the beginning of OPPS, says Jugna Shah, MPH, president and founder of Nimitt Consulting, based in Washington, D.C., and Spicer, Minnesota.
CMS is proposing a new status indicator to be assigned to laboratory tests so when the tests are the only service on a claim, CMS will pay for them separately under the Clinical Laboratory Fee Schedule without providers having to do anything additional from a reporting perspective.
The 2016 OPPS proposed rule introduces APC restructuring, new comprehensive APCs, and many other potential changes for next year. Jugna Shah, MPH, and Debbie Mackaman, RHIA, CPCO, CCDS, review the proposals and what they could mean for providers.
We’re 43 (calendar) days from ICD-10 implementation. We’ve only got 31 working days until October 1. If you are all set for ICD-10, you’re probably fine tuning your coding and documentation, maybe...
CMS has repeatedly tweaked its logic regarding comprehensive APCs since inception. Dave Fee, MBA, reviews the latest changes regarding complexity adjustments, as well as new and deleted codes.
CMS has released a document to clarify questions providers raised about its recent guidance on ICD-10-CM, including answers on how the agency is defining a family of codes.
Although CMS did not propose any changes to the 2-midnight rule in the fiscal year 2016 IPPS proposed rule, it signaled its intention to address short stays in the calendar year (CY) 2016 OPPS proposed rule. CMS followed through by introducing several proposed changes to the 2-midnight rule.
A recent salary survey conducted by our sister publication Medical Records Briefing found the same trends prevail year after year: the 145 HIM professionals who responded feel they are overworked and underpaid.
A Comprehensive Error Rate Testing (CERT) study found insufficient documentation to be the cause of 97% of improper payments for certain kyphoplasty and vertebroplasty procedures, according to the Medicare Quarterly Compliance Newsletter.
CMS and the American Medical Association (AMA) may have made peace regarding ICD-10, but it seems some members of Congress didn’t get the memo. Reps. Marsha Blackburn, R-Tenn., and Tom E. Price, R-Ga...
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.
CMS continues to move toward increased packaging with its policies in the 2016 OPPS proposed rule released July 2, with additional comprehensive APCs (C-APC) and extensive APC reconfigurations.
Multiple surveys have shown that physician practices are lagging behind in preparation for ICD-10. CMS recently released a Quick Start Guide that outlines five steps healthcare professionals should...
A survey conducted in May and June 2015 found providers have completed many steps toward ICD-10 implementation, but lag behind in testing and expect to continue managing the impact after the deadline.
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.
A Comprehensive Error Rate Testing (CERT) study found that the improper payment rate for radiation therapy planning claims was significantly higher than many other physician specialty services, according to the Medicare Quarterly Compliance Newsletter .
The American Medical Association (AMA) is trying to get a seat at the ICD-10 table by resolving to request inclusion as one of the Cooperating Parties. Mind you, today’s resolution at the AMA annual...
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.
CMS declared its second week of ICD-10 end-to-end testing , held from April 27 through May 1, a success. Approximately 875 participants submitted 23,138 test claims during the week and CMS accepted...
A Comprehensive Error Rate Testing (CERT) contractor special study found improper payments on Medicare Part B claims including HCPCS code 84999 (unlisted chemistry procedure) submitted from October to December 2013, according to the latest Medicare Quarterly Compliance Newsletter .
Providers have one last chance to volunteer for ICD-10 end-to-end testing, with CMS extending the deadline to sign up for the July testing period through May 22.
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.
CMS released updated I/OCE specifications in January with several changes that could require providers to examine claims submitted early in 2015 that include comprehensive APCs (C-APC) to ensure proper payment.
Dave Fee, MBA, identifies updates to CMS' programming logic for comprehensive APCs and provides a step-by-step approach to determine whether a complexity adjustment will be applied.
A Recovery Auditor automated review of claims for cardiovascular nuclear medicine procedures found potential incorrect billing due to lack of medical necessity, according to the latest Medicare Quarterly Compliance Newsletter.
A Comprehensive Error Rate Testing (CERT) study of transcatheter aortic valve replacement/implantation (TAVR/TAVI) services found that approximately one third of the claims received improper payments, mostly due to insufficient documentation, according to the latest Medicare Quarterly Compliance Newsletter.
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.
Providers who want to volunteer to participate in CMS' final round of ICD-10 end-to-end testing have until April 17 to sign up through their Medicare Administrative Contractor's (MAC) website.
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.
Just when we were starting to feel really good about ICD-10’s chances of being implemented, AHIMA has learned that Chairman of the House Rules Committee Pete Sessions, R-Texas, is looking to draft...
The January quarterly I/OCE update includes new modifiers, changes related to expanded packaging, and continued refinement of CMS' skin substitutes categories, but the biggest change for outpatient hospitals is the implementation of comprehensive APCs (C-APC).
Add another nail in the “delay ICD-10 because the industry isn’t ready” coffin. CMS d eclared its end-to-end testing week from January 26 through February 3 a success . A total of 661 volunteers...
