Corporate Compliance

Transmittals and MLN Matters articles: CMS advises on documentation, notifies of new waived tests, and more

Medicare Insider, June 28, 2011

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CMS advises on conflicting documentation

CMS has issued a special MLN Matters article on DRG coding vulnerabilities for inpatient hospitals. In addition to other guidance, the article specifically addresses conflicting provider documentation:

Remember that the “Coding Clinic, First Quarter 2004” states, if there is conflicting physician documentation, and the coder fails to query the attending physician to resolve the conflict, hospitals are encouraged to code the attending physician’s version. However, the failure of the attending physician to mention a consultant’s diagnosis is not a conflict. So, if the consultant documents a diagnosis and the attending physician doesn’t mention it at all, it is acceptable to code it. A conflict occurs when 2 physicians call the same condition 2 different things – for example, the attending physician documents a sprained ankle and the orthopedist refers to the same injury as a fracture.

View the MLN Matters article.

CMS instructs on admission date/statement covers period

CMS has released a special edition MLN Matters article to remind providers of the definitions for reporting the admission date and statement covers period on claims.

View the MLN Matters article.

CMS corrects calculation for time value of money

On June 17, CMS issued a transmittal to technical correction to the formula used to compute the time value of money when Medicare contractors perform outlier reconciliation under the IPPS, IRF PPS, LTCH PPS, IPF PPS and OPPS.

Effective date: July 1, 2011
Implementation date: July 1, 2011

View the transmittal.

CMS posts new waived tests

CMS has released its regular update to inform contractors of new waived tests under CLIA.

Effective date: October 1, 2011
Implementation date: October 3, 2011

View the transmittal.

View the MLN Matters article.

CMS posts ICD-9-CM update reminder

CMS has issued a recurring update notification to remind contractors of the ICD-9-CM update that is effective for the dates of service on and after October 1, 2011.

Effective date: October 1, 2011
Implementation date: October 3, 2011

View the transmittal.



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