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.
Providers struggle to reconcile conflicts between recent CMS regulations and the CPT® Manual and other AMA publications. Jugna Shah, MPH , Valerie A. Rinkle, MPA , and Linda S. Dietz, RHIA, CCS, CCS-P , look at specific areas of confusion and how to code them accurately.
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 .
The American Hospital Association (AHA), along with four hospital associations and several hospitals, filed two complaints April 14 in opposition of CMS’ 2-midnight rule for inpatient admissions, according to an AHA press release.
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.
On Monday, the Senate passed a House of Representatives bill on Medicare payments that included a provision to delay ICD-10 implementation until at least October 1, 2015.
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.
CMS posted updated versions of all the guidance documents posted on the Inpatient Hospital Review site. The agency also posted a new document reviewing the status of the probe and educate audits, including examples of some of the errors the MACs have found in audits thus far.
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.
Changes implemented by the 2014 OPPS Final Rule resulted in the addition and deletion of many codes in the January I/OCE update. Dave Fee, MBA , reviews some of the most important modifications, including changes to evaluation and management services and device reporting.
CMS Administrator Marilyn Tavenner reiterated last week that ICD-10 implementation would not be delayed again, as CMS prepares for end-to-end testing of providers this summer.
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.
Maybe the AMA’s letter did the trick. Or maybe CMS just thought better of its decision not to conduct end-to-end testing prior to ICD-10 implementation. According to MLN Matters® SE1409 , CMS will...
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.
CMS will present the eHealth Summit: Road to ICD-10 from 9 a.m. to 3:30 p.m., Friday, February 14, in Baltimore and is inviting interested parties who cannot attend in person to register for a live webcast of the sessions .
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.
In addition to increased packaging and collapsing of E/M clinic visit level CPT ® codes in the 2014 OPPS -Final Rule, CMS made additional changes that will have an immediate impact on reimbursement or require operational changes for providers.
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.
A recent survey of healthcare payers and providers by accounting firm KPMG shows that many organizations are lagging when it comes to ICD-10 testing. Nearly three-quarters of respondents said they had yet to begin end-to-end ICD-10 testing or were not planning on conducting it.
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 .
CMS did not finalize a proposal to collapse all evaluation and management visits into three codes, but did change clinic visit level coding. Jugna Shah, MPH, and Valerie A. Rinkle, MPA, review some of the major changes to E/M levels for 2014 and the new codes introduced. introduced.
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.
Documentation for vertebral augmentation procedures (VAPs) must adhere to Local Coverage Determination (LCD) policies in order to be paid by Medicare. CMS recently provided guidance for these claims in the Medicare Quarterly Provider Compliance Newsletter .
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
Worried that your vendors won't be ready for ICD-10? CMS has a tip sheet for talking with your vendors on its website. In addition, CMS recently added five new resources: Introduction to ICD-10...
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.
The audit landscape continues to change as Recovery Auditors expand prepayment reviews and CMS implements its new 2-midnight rule. Debbie Mackaman, RHIA, CPCO, Ralph Wuebker, MD, MBA, and Kimberly Hoy Baker, JD, review some of the recent changes to audit focus areas.
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.
CMS recently released five online resources to aid providers in their ICD-10 implementation efforts. Although CMS designed some of these resources with providers in mind, much of the information is applicable to hospitals, payers, and vendors as well.
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 .
The 2014 IPPS Final Rule was supposed to be implemented with enforcement beginning October 1, but one of its most controversial aspects has seen another delay in enforcement, with major healthcare trade groups seeking more.
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.
Some of the most sweeping changes in OPPS history were proposed in the 2014 rule, including new packaging rules, quality measures, and changes to evaluation and management. Jugna Shah, MPH, and Dave Fee, MBA, look at some of the changes and how they could impact providers.
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.
With less than a year until ICD-10 implementation, many facilities have yet to even begin training. A recent Association of Clinical Documentation Improvement Specialists survey shows how far along facilities are and their concerns as October 1, 2014, nears.
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.
CMS announced that it is postponing the eHealth Provider Webinar on ICD-10 compliance that was scheduled for October 1. CMS has not announced a reschedule date.
Hospitals are being incorrectly reimbursed for preadmission testing that occurs within the three days prior to admission, according to Recovery Audit findings.
CMS’ proposed 2014 OPPS rule is set to introduce many changes, such as more packaged services, including lab tests and add-on codes. Jugna Shah, MPH; Dave Fee, MBA; Kimberly Anderwood Hoy, JD, CPC; and Valerie A. Rinkle, MPA, offer their insight on what effect these changes could have for providers.
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.
CMS has been releasing ICD-10 National Coverage Determination (NCD) “omnibus” transmittals since September 2012, which gives providers some information about CMS’ coverage policies moving forward...
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).
The 2014 IPPS Final Rule contains two significant changes that will impact coders: the 2-midnight inpatient presumption and the Part A to Part B rebilling. Marc Tucker, DO, FACOS, FAPWCA, MBA, and Kimberly Anderwood Hoy Baker, JD, CPC, review the key provisions of these changes.
