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.
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.
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.
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...
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.
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).
CMS’ Pat Brooks, RHIA, senior technical advisor, Hospital and Ambulatory Policy Group, and AHIMA’s Sue Bowman, MJ, RHIA, CCS, FAHIMA, senior director, coding policy and compliance, reviewed basic ICD-10 information during a CMS National Provider Call August 22.
Do you ever feel like everything is on YouTube? In some cases, it’s more than you want to see, but the video site can be extremely helpful for coders who want to watch procedures. For example, search...
Evaluation and management (E/M) coding and reimbursement for hospital outpatients could change dramatically if CMS finalizes its proposal to replace current E/M CPT ® codes with three G codes. Dave Fee, MBA, Peggy S. Blue, MPH, CCS-P, CPC, Jugna Shah, MPH, Kimberly Anderwood Hoy, JD, CPC, Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, and Valerie A. Rinkle discuss the possible impact if CMS finalizes its proposal.
CMS added three new HCPCS C codes and one G code to the integrated outpatient code editor (I/OCE) as part of the October quarterly update. The new codes are effective October 1.
CMS added additional ICD-10 MLN educational resources to its website and will be hosting an ICD-10 National Provider Call August 22. The new MLN educational resources include two fact sheets and a...
First we saw the new ICD-10-PCS codes and guidelines in May, followed by the new ICD-10-CM codes in June and the ICD-10-CM guidelines in July. Now we have updated general equivalence mappings (GEMs)...
CMS has been gathering information about the use of observation services and short inpatient hospital stays because hospitals have been placing patients in observation for longer periods of time. CMS recently finalized a change that will substantially affect how hospitals bill for observation stays, long outpatient stays, and short inpatient stays.
Eight CPT ® codes for multianalyte assays with algorithmic analyses (MAAA) procedures are now classified as not covered under OPPS (status indicator E), retroactive to January 1, 2013. These codes are now subject to I/OCE edit 9.
CMS and the Office of the National Coordinator for Health Information Technology recently hosted a listening session to gather industry feedback and concerns about health information technology adoption. Read some of the highlights of the session and comments from providers in the field.
The recent ACDIS 2013 ICD-10 Preparation Survey found that 48 % of respondents don’t plan to add coding staff members to meet the challenge of ICD-10 implementation. Meanwhile, 66 % of respondents said they don’t plan to hire additional clinical documentation improvement (CDI) staff.
The U.S Centers for Disease Control and Prevention recently posted the updated ICD-10-CM guidelines . Narrative changes in the guidelines appear in bold text and content that moved within the guidelines is underscored.
CMS’ July update to the Integrated Outpatient Code Editor features new codes, new APCs, and a new modifier. Dave Fee, MBA, explains the most noteworthy changes for this quarter.
October 1, 2014, is a little more than 14 months away. Where do your ICD-10 implementation plans stand? Do you know what resources you’ll need for the transition or when you should providing training...
The demand for coding labor may increase as much as 20%–40% over the next two years, according to a recent report, The State of H.I.M.: A Study of the Impact of ICD-10, CDI, and CAC Initiatives Within the Health Information Management Community. Trust Healthcare Consulting Services, LLC, which published the report, surveyed more than 300 HIM professionals in all types of healthcare facilities in nearly every state. The majority of participants (84%) were HIM directors.
Coders who want to get a head start on coding in ICD-10-CM can now download the 2014 ICD-10-CM codes from the Centers for Disease Control and Prevention (CDC) and CMS websites. The updated coding guidelines for ICD-10-CM are not available yet.
CMS is reexamining inpatient criteria because it has seen a significant increase in the number of patients spending more than 24 hours in observation. Providers are worried that a Recovery Auditor will deny a short inpatient stay for lack of medical necessity and recoup payment years later. So instead, some facilities place patients in observation for longer time periods.
Do EHRs enable fraud and abuse by encouraging upcoding? What other factors could have led to higher levels of E/M coding over the past decade? Who or what organizations are responsible for ensuring compliance?
ICD-10 implementation is less than 16 months away, but a recent survey by TrustHCS and AHIMA reveals that 25% of responding healthcare organizations have not yet established an ICD-10 steering committee.
CMS is reexamining inpatient criteria because it has seen a significant increase in the number of patients spending more than 24 hours in observation. James S. Kennedy, MD, CCS, CDIP, and Kimberly Anderwood Hoy, JD, CPC, discuss CMS’ proposed changes and how they could affect outpatient observation services.
Hospitals continue to report dramatic increases in Recovery Auditor (RA) activity, according to the latest RAC Trac survey results released June 4. The survey found that the number of medical record requests for survey respondents has increased by 53% in comparison to the cumulative total reported in the third quarter of 2012.
CMS released three FAQs about ICD-10 billing, including how to bill encounters that cross the ICD-10 implementation date. That’s October 1, 2014 in case you forgot. And a claim cannot contain both...
CMS released Special Edition MLN Matters ® Article SE1325 to clarify split billing for certain institutional encounters that span the ICD-10 implementation date of October 1, 2014.
CMS has uploaded the latest version of the ICD-10-PCS codes that coders will use for reporting inpatient procedures beginning October 1, 2014. The new files also include the 2014 ICD-10-PCS Official Guidelines for Coding and Reporting .
Consider the following: A beneficiary is admitted to a hospital pursuant to a physician order and receives medically necessary care spanning at least two midnights. CMS will consider this appropriate for payment under Medicare Part A, according to the FY 2014 IPPS proposed rule released April 26. Actuaries estimate that this proposal for what constitutes appropriate inpatient care would increase IPPS expenditures by $220 million due to an expected net increase in inpatient encounters. CMS proposes a 2% reduction to offset projected spending increases.
Providers were glad to see CMS' ruling (CMS-1455-R) released March 13 (published in the Federal Register on March 18), which allows full Part B payment for inpatient stays that had been denied as not reasonable and necessary. The ruling had very few details on how the process would work, but on March 22, CMS published Transmittal R1203OTN instructing contractors and providers on the details.
CMS has had a couple of busy months releasing various FY 2014 proposed rules. On May 1, CMS issued its proposed rule for skilled nursing facilities (SNF) . On May 2, the agency issued its proposed rule for inpatient rehabilitation facilities (IRF) . The two rules come in the wake of the IPPS proposed rule issued April 26.
CMS not only redefines inpatient status in the 2014 IPPS proposed rule, but it also discusses the ‘why’ and ‘how’ physicians should document the defining characteristic of all admissions: medical necessity. Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS, and Cheryl Ericson, MS, RN, CCDS, CDIP, explain how the proposals could impact inpatient admissions.
CMS is translating only 27% of its current National Coverage Determinations (NCD) from ICD-9-CM to ICD-10-CM, according to Janet Anderson Brock, CMS’ director of the Division of Operations and Information Management, Coverage and Analysis Group Center for Clinical Standards and Quality.
Under a new ruling, CMS allows full Part B payment for inpatient stays that a contractor denies because it deems them to be not reasonable and necessary. David Danek and Ann Marshall, both from CMS, explain how the rebilling works under the ruling and what will be different under a simultaneously released proposed rule.
CMS corrected edit 84, added five APCs, deleted two APCs, and changed the description of another as part of the April updates to the I/OCE. Dave Fee, MBA, reviews the most significant changes CMS implemented
Successful appeals can actually lead to CMS policy changes. Facilities have been successfully appealing to receive Part B payments after a Medicare review contractor denied a Part A stay as not medically necessary. As a result, CMS is changing its policy on rebilling for Part B services.
