CMS has issued both a National Coverage Determination (NCD) Transmittal 143 and Medicare Claims Processing Transmittal 2473 on the coverage of extracorporeal photopheresis for the treatment of bronchiolitis obliterans syndrome (BOS) in certain circumstances under clinical research studies.
Providers will soon be reimbursed by Medicare for a new, less-invasive aortic valve replacement procedure. Medicare Acting Administrator Marilyn Tavenner announced CMS’ decision to pay for transcatheter aortic valve replacement under specific conditions.
CMS released its latest MLN Medicare Quarterly Provider Compliance Newsletter in April. The newsletter features educational information for providers related to recent audit targets and findings.
The American Health Information Management Association (AHIMA) continues to advocate for no delay in the implementation date for ICD-10-CM and ICD-10-PCS.
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.
CMS continues to add more screening services to the list of covered preventative services. The newest additions involve screenings for sexually transmitted infections (STI).
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.
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.
Perhaps you're familiar with the following scenario: A hospital submits a short-stay inpatient (Part A) claim. An auditor, such as a RAC or MAC, reviews the claim and deems the admission to be not reasonable and necessary due to the hospital billing the wrong setting. The auditor issues a denial for the full amount of the claim. Although the hospital may rebill for certain Part B ancillary services before the timely filing limit, it may not bill for any of the other outpatient services denied as part of the inpatient claim.
Coders who are preparing for the upcoming transition to ICD-10-CM should note some significant changes to the coding guidelines for glaucoma coding as part of the 2012 updates to the ICD-10-CM Official Guidelines for Coding and Reporting .
The Office of the Inspector General (OIG) stated in its recent publication, “Hospital Incident Reporting Systems Do Not Capture Most Patient Harm,” that a series of reports examining adverse events in hospitals shows that for the hospitals it surveyed, the incident reporting systems only tracked approximately 14% of incidents.
CMS added four new J codes for reporting drugs and biologicals that previously did not have specific codes available as part of the 2012 Outpatient Prospective Payment System updates ( Transmittal 2376 ).
CMS decided not to cap outpatient payment rates for cardiac resynchronization therapy defibrillator procedures at the standardized inpatient rate as part of the calendar year 2012 Outpatient Prospective Payment System final rule. In addition, CMS finalized several changes regarding payments for 11 cancer centers, drug payment calculations, and physician supervision. Jugna Shah, MPH, and Kimberly Anderwood Hoy, JD, CPC, explain the changes facilities will see in 2012.
Although the New Year marked the deadline for Version 5010 compliance, CMS recently reminded providers that it will not exercise enforcement until April 1, 2012. Despite the 90-day discretionary period, CMS urged providers that they should complete the transition to Version 5010 as soon as possible. This extension will not have any effect on the implementation date for ICD-10-CM/PCS, which remains set for October 1, 2013.
Coders should already be familiar with the 285 new, revised, and deleted ICD-9-CM codes that CMS finalized for fiscal year (FY) 2012. However, it’s critical that providers also examine how these changes directly affect MS-DRG assignment. Robert Gold, MD, examines a number of these changes, including MS-DRG assignment related to cardiac-specific comorbidities, autologous bone marrow transplants, excisional debridement, and thoracic aneurysm repair.
Fortunately for providers, CMS decided not to cap outpatient payment rates for cardiac resynchronization therapy defibrillator (CRT-D) procedures at the standardized inpatient rate. The agency announced its decision as part of the CY 2012 OPPS final rule released November 1, 2011.
Looking for the 2012 ICD-10-CM code updates? Want to see what's included in the final regular update before implementation? Check the CMS’ ICD-10-CM and GEMS website. CMS posted the 2012 ICD-10-CM:...
CMS’ Office of E-Health Standards and Services (OESS) won’t enforce compliance with the HIPAA 5010 transaction set until March 31, 2012, the agency announced November 17 . The 90-day delay will not...
Representatives from the American Hospital Association (AHA), the American Health Information Management Association, and the Centers for Disease Control and Prevention will discuss ICD-10...
CMS created the following four podcasts based on the January 12 national provider call, “Preparing for ICD-10 Implementation in 2011:” Welcome and ICD-10 Overview Implementation Strategies for 2011...
Well, CMS apparently wants to make sure everyone tests the HIPAA Version 5010 transaction sets. CMS previously announced two national testing days, and is adding 5010 testing week. CMS scheduled 5010...
CMS recently posted the 2012 ICD-10-PCS codes and coding guidelines . A summary of the major changes for 2012 states that there are 1,182 new codes, 381 revised titles, and 1,345 deleted codes. In...
CMS will host a national provider teleconference, "CMS ICD-10 Conversion Activities," on May 18, 1 - 2:30 p.m. EST. Presenters will discuss the ICD-10 conversion process currently taking place within...
As many of you know, before we switch to ICD-10-CM/PCS, we first will be transitioning to HIPAA Version 5010. In fact, that date is less than one year away. By January 1, 2012, providers need to be...
CMS recently posted agendas for what will be the last ICD-9-CM Coordination & Maintenance Committee meeting to address code updates for ICD-9 and ICD-10 before the partial code freeze is...
CMS included nine topics related to ICD-10-CM/PCS on its tentative agenda for the ICD-9-CM Coordination and Maintenance Committee meeting March 9-10. This is the final meeting to address ICD-9-CM and...
I know there are some of you out there who missed the recent CMS national provider call. For anyone looking to catch up on this recent information session, CMS posted to its ICD-10 webpage a...
You can expect ICD-10 updates to follow the same timeline that you are already accustomed to for ICD-9—almost. An ICD-9-CM Coordination and Maintenance Committee Meeting was held September 15-16,...
CMS has released the 2011 versions of the ICD-10-CM/PCS crosswalks, also known as the General Equivalence Mappings (GEM) on its ICD-10 website . In addition, CMS also posted a document titled “ICD-10...
CMS will hold a Special Forum to receive input on the development and implementation of its hospital value-based purchasing program, as required by Section 3001 of the Affordable Care Act. The...
CMS posted this week the following ICD-10-PCS files for 2011 to its website: Official ICD-10-PCS Coding Guidelines 2011 Version: What's New Code Tables and Index Code Descriptions ICD-10-PCS...
