I’m almost afraid to read my email these days. It seems like every day brings a new group trying to delay ICD-10 or another piece of legislation that ICD-10 opponents might slip delay language into...

Beginning January 1, 2015, physicians will no longer need to provide certification for an inpatient admission unless the admission is expected to last for at least 20 days or the case is an outlier.

CMS removed two procedures from the inpatient-only list and added one in the 2015 OPPS final rule , released October 31.

CMS finalized a new data collection requirement for services performed in off-campus, provider-based clinics in the 2015 OPPS final rule , which was released October 31.

Editor's note: Jugna Shah, MPH, president and founder of Nimitt Consulting, writes a bimonthly column for Briefings on APCs, commenting on the latest policies and regulations and analyzing their impact on providers.

CMS will host a national provider call on transitioning to ICD-10 at 1:30 p.m. (Eastern) Wednesday, November 5.

The October update to the OPPS and Integrated Outpatient Code Editor (I/OCE) includes a payment correction, in addition to new HCPCS codes and other changes. Dave Fee, MBA, reviews CMS' changes and details the retroactive payment correction.

Recovery Auditors have uncovered incorrect secondary diagnoses in patients who underwent amputations for musculoskeletal and circulatory system disorders. CMS revealed the findings in its Quarterly Compliance Newsletter .

ICD-10 implementation will impact different specialties and hospital departments in distinct ways. Andrew D. Boyd, MD, and Neeta K. Venepalli, MD, MBA , recently conducted a pair of studies to determine the financial and informational impact of ICD-10 on a variety of specialties.

CMS is introducing four new HCPCS modifiers to specifically define subsets of modifier -59 (distinct procedural service), the most frequently used modifier.

CMS refined and updated its Comprehensive APC policy in the 2015 OPPS proposed rule released July 3, adding a new complexity adjustment factor. CMS also proposes significantly expanding the packaging of ancillary services. Additionally, the proposed rule includes a significant change to requirements related to inpatient physician certification.

CMS proposed a major change to physician certification requirements in the 2015 OPPS proposed rule. Kimberly A.H. Baker, JD and James S. Kennedy, MD, CCS, CDIP, break down how the change could affect inpatient admissions.

The 2015 IPPS final rule , released August 4, focuses on quality initiatives and includes no ICD-9-CM diagnosis or procedure code changes. However, CMS did finalize some MS-DRG changes for Fiscal Year 2015.

CMS introduced a singificant change to physician certification requirements in the 2015 OPPS proposed rule.

Improper ICD-9-CM code assignment led to incorrect grouping of claims to MS-DRG 857 (postoperative or posttraumatic infections with operating room procedure with complications and comorbidities), according to Recovery Auditors. CMS released the findings in the July 2014 Medicare Quarterly Provider Compliance Newsletter .

The July quarterly I/OCE update from CMS brought few new APCs or edit updates, but did deliver a new modifier. Debbie Mackaman, RHIA, CHCO, Jugna Shah, MPH , and Denise Williams, RN, CPC-H , explain how to use the modifier, as well as the impact of APC changes.

The 2015 OPPS proposed rule , released July 3 by CMS, is relatively short at less than 700 pages, but contains refinements to the previously introduced Comprehensive APC policy and significant packaging of ancillary services.

CMS focused on quality measures in the 2015 IPPS proposed rule, released April 30. Kimberly A.H. Baker, JD, Cheryl Ericson, MS, RN, CCDS, CDIP, James S. Kennedy, MD, CCS, CDIP ,and Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, highlight the most significant proposed changes.

CMS' first maintenance update to National Coverage Determinations (NCDs) for ICD-10-specific conversions and coding includes changes to 29 NCDs.

CMS made relatively few changes in the April quarterly I/OCE update, introducing four new APCs, deleting one, and reclassifying several skin substitute codes.

The April quarterly I/OCE update brought relatively few changes, though CMS has continued to refine skin substitute reporting. Dave Fee, MBA, reviews the updated skin substitute categories, as well as updates to laboratory billing.

The ICD-10-PCS codes and guidelines for 2015 look exactly the same as those for 2014.

In the IPPS Proposed Rule released April 30, CMS announced the Cooperating Parties would not be adding any new ICD-9-CM codes for Fiscal Year 2015.

In January, I wrote about the perfect storm that led to the release of the 2014 OPPS final rule. We endured a later-than-usual release, errors in the data files and a release of updated files, a government shutdown, and a vastly shortened window between the release of the final rule and implementation on January 1. Judging by the confusion among providers?and corrections and clarifications coming from CMS on what seems like a weekly basis on a wide range of issues?we're still not in the clear.

CMS’ 2015 IPPS proposed rule , released April 30, focuses on quality measures, such as the hospital-acquired condition (HAC) reduction, readmissions reduction, and hospital value-based purchasing and hospital readmissions reduction programs.

A review of Medicare CT scan claims from July 2011 to June 2012 found that 16% claims had an improper payment rate, according to the most recent Medicare Quarterly Provider Compliance Newsletter .

In the wake of the latest ICD-10 implementation delay, coders and other healthcare professionals are looking for ways to continue with their implementation and training. They are also looking for ways to minimize the disruptions the delay may cause.

The January 2014 quarterly I/OCE update included nearly 400 new HCPCS Level II codes, but the most significant changes for providers may center on relatively few codes, as a result of modifications CMS made in the 2014 OPPS final rule.

In the Medicare Quarterly Provider Compliance Newsletter , CMS writes about auditor findings for MRI scans that did not meet medical necessity and how to ensure documentation that supports it.

The AHA’s Coding Clinic is now offering answers to ICD-10 questions. In fact, Coding Clinic is no longer accepting questions about ICD-9-CM.

CMS will conduct full end-to-end testing—from submission to remittance advice—with a select sample of providers in July. CMS first announced the decision in MLN Matters® SE1409 and provided additional details during the February 20 webcast, CMS ICD-10 Readiness.

An overwhelming 87% of respondents to a recent survey by Navicure of physician practices said they are at least "somewhat confident" they will be ready for ICD-10 implementation by October 1.

The World Health Organization (WHO) is delaying the launch of ICD-11 until 2017. The WHO did not formally announce a delay, but its website now lists ICD-11 as due by 2017.

Jugna Shah, MPH, and Valerie A. Rinkle, MPA, examine the 2014 OPPS Final Rule and explain which services are now packaged, including drugs and biological that function as supplies when used in diagnostic or surgical procedures, clinical diagnostic lab tests, and device removal procedures.

One of the most radical changes CMS proposed in this year’s OPPS was to collapse the five levels of E/M CPT ® codes and replace them with three new HCPCS G-codes, including one APC for all clinic visits, one for all Type A ED visits, and one for all Type B ED visits.

CMS released a new MLN Connects video to help coders prepare for the upcoming transition to ICD-10-CM

Recovery Auditors have identified substantial overpayments for inpatient psychiatric services directly following an acute care stay within the same facility, according to CMS’ MLN Matters® SE1401 .

Coders have until September 30, 2015, to pass AAPC’s ICD-10 proficiency test in order to retain their credentials. AAPC recently added another way to prove proficiency that includes an online training portion, in addition to the previously available timed assessment.

CMS released version 31 of the MS-DRG grouper for ICD-10 in November. Providers can use the grouper to identify MS-DRG shifts and payment changes under ICD-10. The Final ICD-10 MS-DRG v32 logic, which will be implemented on October 1, 2014, will be subject to rulema

In its 2014 OPPS Final Rule , CMS finalized its proposal to replace existing evaluation and management CPT ® clinic visit codes with a single HCPCS G-code.

CMS created a 2-midnight presumption and benchmark as part of the 2014 IPPS Final Rule as a way to clarify its guidelines for inpatient admission. However, the American Hospital Association (AHA) and American Medical Association (AMA) believe the clarification creates more confusion.

Some hospitals are incorrectly reporting lymphoma and leukemia MS-DRGs for patients who are admitted and treated for anemia and dehydration, according to the Medicare Quarterly Provider Compliance Newsletter .

Physicians believe they are providing quality care, which gives them high job satisfaction. However, the problems associated with using electronic health records decreased that satisfaction, according to a recent RAND survey.

Small and mid-sized hospitals are increasing their ICD-10 training for staff, according to a recent Health Revenue Assurance Associates (HRAA) survey of 200 healthcare professionals. However, many still lag behind CMS’ timeline for dual coding and other implementation aspects.

In order for coders to report ICD-9-CM procedure code 96.72 (continuous invasive mechanical ventilation for 96 consecutive hours or more), the provider must document that the patient received more than 96 hours of continuous ventilation. A recent OIG report found that 96% of claims incorrectly included code 96.72 between 2009 and 2011.

CMS added modifier -AO (provider declined alt payment method) and new HCPCS codes to the I/OCE as part of the October 2013 quarterly update found in Transmittal 2763.

Hospitals are being incorrectly reimbursed for preadmission testing that occurs within the three days prior to admission, according to Recovery Audit findings.

Some providers are billing only add-on codes without their respective primary codes, resulting in overpayments, according to CMS. Add-on codes billed without their primary codes are considered an overpayment, with one exception.

Health information exchange between hospitals and other providers has risen by 41% between 2008 and 2012, according to research published in Health Affairs from the Office of the National Coordinator for Health Information Technology (ONC).