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.
CMS instructed fiscal intermediaries (FI) and Medicare Administrative Contractors (MAC) to hold claims containing CPT ® code 33249 (insertion or replacement of permanent pacing cardioverter-defibrillator system with transvenous lead[s], single or dual chamber) and HCPCS code C1882 (cardioverter-defibrillator, other than single or dual chamber [implantable]).
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.
A one-year delay in ICD-10-CM/PCS isn’t a slam dunk. “We’re recommending it, but it’s not [guaranteed],” said Denise Buenning, group director CMS Office of E-Health Standards and Services. Buenning...
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.
The Office of E-Health Standards and Services (OESS) announced a second delay in the enforcement of HIPAA 5010, CMS announced March 15 . OESS announced the first enforcement delay November 17, 2011...
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.
The January update to the Integrated Outpatient Code editor generally includes a large number of changes and the January 2012 update is no exception. Dave Fee, MBA, highlights the most significant changes including the addition of modifier –PD, which he calls one of the real sleepers in this release.
CMS continues to add more screening services to the list of covered preventative services. The newest additions involve screenings for sexually transmitted infections (STI).
Modifier -PD (diagnostic or related nondiagnostic item or service provided in a wholly owned or wholly operated entity to a patient who is admitted as an inpatient within three days or one day) is now included in the I/OCE, according to January updates detailed in Transmittal 2370 .
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.
Big news regarding the ICD-10-CM/PCS implementation timeline came out this morning during the American Medical Association (AMA) National Advocacy Conference in Washington, DC. Per CMS acting...
CMS added modifier -PD (diagnostic or related nondiagnostic item or service provided in a wholly owned or wholly operated entity to a patient who is admitted as an inpatient within three days or one day) to the Integrates Outpatient Code Editor (I/OCE) as part of the January updates detailed in Transmittal 2370 .
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.
