Corporate Compliance

Other Issuances: CMS advises on SNF consolidated billing, claims processing issues, and more

Medicare Insider, May 24, 2011

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CMS notifies on certain HCPCS codes and consolidated billing

CMS recently issued a notice to its listservs regarding certain HCPCS codes that should have been excluded from the skilled nursing facility (SNF) consolidated billing and allowed to be paid separately. CMS states:

Effective Tuesday, July 5, 2011, for dates of service on or after Saturday, January 1, 2011, claims processing edits for institutional claims for the codes for Computerized Axial Tomography (CT) Scans (HCPCS 74176, 74177, and 74178) will be revised to allow separate payment for these codes outside of the SNF consolidated billing bundled payment.  These codes were already included in the annual update for physician and practitioner claims and claims have processed correctly.

Institutional providers that submitted claims with dates of service on or after Saturday, January 1, 2011 would have had claims denied for these services.  These providers should contact their Medicare Fiscal Intermediary or Medicare Administrative Contractor to have the claims reopened and reprocessed.

In addition, a policy decision has been made by CMS that Dacogen (HCPCS code J0894) meets the clinical parameters for exclusion from SNF consolidated billing as a high-intensity chemotherapy drug.  Therefore, effective Monday, October 3, 2011, for claims with dates of service on or after Saturday, January 1, 2011 claims processing edits will be revised to allow for the separate payment of HCPCS code J0894 outside of the SNF consolidated billing bundled payment.

Institutional providers, physicians, and practitioners that submitted claims with dates of service on or after Saturday, January 1, 2011 would have had claims denied for these services.  These providers should contact their Medicare Carrier, Fiscal Intermediary, or Medicare Administrative Contractor to have the claims reopened and reprocessed.

CMS advises on claims issues

CMS has posted several items regarding claims issues, including reprocessing of certain preventive services claims, suspension of certain claims due to errors in calculating the deductible, and more.

Continue reading CMS’ claims issues guidance.

OIG reviews HIPAA oversight

On May 16, the OIG issued a report on CMS’ oversight and enforcement of HIPAA. The OIG determined that CMS had limited assurance that controls were in place and operating as intended to protect electronic protected health information (ePHI), thereby leaving ePHI vulnerable to attack and compromise.

View the OIG report.

CMS incorporates changes to hospital CoPs manual

CMS has posted an advance copy of changes to Appendix A of the State Operations Manual, concerning several regulatory updates on orders for rehab and respiratory care. CMS is also clarifying guidance regarding administration of blood transfusions and IV medications.

View the changes.



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