On March 13, CMS issued a notice of ruling that establishes a policy that revises the current policy on Part B billing following the denial of a Part A inpatient hospital claim that a Medicare review contractor deemed to be not reasonable or necessary. The revisions are intended as an interim measure until CMS can finalize an official policy to address the issues raised by the Administrative Law Judge and Medicare Appeals Council decisions going forward.
CMS added 410 new codes and seven new therapy and patient condition modifiers to the Integrated Outpatient Code Editor (I/OCE) as part of the January 2013 update. Dave Fee, MBA, highlights the key changes to the I/OCE.
More than 450 healthcare organizations will participate in CMS’ Bundled Payments for Care Improvement Initiative . CMS announced the specific organizations in January, and some participants will begin receiving bundled payments as early as April. The program will be in effect for three years.
CMS is currently updating its ICD-10 implementation guides for practices, small hospitals, and payers. The agency has already posted the updated guide for small and medium practices .
Thirty-day readmissions for heart failure, heart attack, and pneumonia occur most frequently for reasons other than the cause of the initial hospitalization, according to a study published in the January 23 issue of the Journal of the American Medical Association (JAMA).
CMS is making a significant change to the Medically Unlikely Edits by changing the edits from line item edits to date of service edits. The change will become effective April 1.
One of AHIMA’s long-time goals is to empower HIM professionals to be heavily involved in the ICD-10 overhaul and perhaps even leading the transition in their facility.
One of the major changes to the 2013 CPT ® Manual is the replacement of the term "physician" with "physician or other qualified healthcare professional" in a wide range of codes. Marie Mindeman and Andrea Clark, RHIA, CCS, CPC-H, discuss how this change affects code assignment.
CMS rescinded Transmittal 2607 and replaced it with Transmittal 2636 to update the add-on code edit file to include a change in the list of primary codes for CPT add-on code 90785 (interactive complexity).
As part of the 2013 OPPS Final Rule, CMS made major changes to how it will reimburse facilities for separately payable drugs and how it will calculate APC relative weights. Jugna Shah, MPH, and Valerie Rinkle, MPA, review the most significant changes in the final rule.
The FY 2013 Office of Inspector General (OIG) Work Plan includes plenty of new additions that might interest inpatient hospitals. Sara Kay Wheeler, Kimberly Anderwood Hoy, JD, CPC, Monica Lenahan, CCS, and William E. Haik, MD, FCCP, CDIP, review those new additions and offer tips for dealing with OIG scrutiny.
If you’re curious about whether something you’ve heard or read about the Recovery Auditor program is true, be sure to check out new information published on the CMS Web site. The agency released a document that addresses 14 common myths about the program.
On January 9, the American Medical Association sent out a notification of errata in the 2014 CPT ® Manual . The AMA followed with a January 16 correction saying the errata file is for the 2013 CPT Manual .
National Government Services, under contract with CMS, will host a series of listening sessions about lessons learned from the Version 5010 upgrade to prepare providers, vendors, and payers for the transition to ICD-10-CM/PCS.
Coding for stent placement procedures will look very different in 2013. The American Medical Association deleted the two CPT ® codes used to report nondrug-eluting intracoronary stent placement procedures.
Hospitals earned a big win with drug payments this year in the 2013 OPPS final rule, released November 1. CMS decided to finalize its proposal to follow the statute and reimburse facilities at the average sales price (ASP) plus 6%.
As part of the 2013 OPPS final rule, CMS finalized a clarification to 42 CFR 419.2(b) that could cause confusion in the future if hospitals are audited by third-party payers or by Medicare contractors who do not fully understand the intent of the language or how CMS develops payment rates, says Jugna Shah, MPH, president of Nimitt Consulting based in Washington, D.C.
CMS recently posted an updated version of the National Correct Coding Initiative (NCCI) manual to the CMS NCCI website . The manual includes changes identified in red text and will be effective with dates of service January 1, 2013.
As part of the 2013 OPPS final rule, CMS finalized a clarification to 42 CFR 419.2(b) concerning packaged services. Jugna Shah, MPH, and Valerie Rinkle, MPA, explain how this clarification could cause confusion in the future if hospitals are audited by third-party payers or by Medicare contractors who do not fully understand the intent of the language or how CMS develops payment rates.
