Corporate Compliance

Other issuances: CMS issues important information for provider regarding the billing of hospital outpatient and inpatient ancillary services

Medicare Insider, February 28, 2012

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CMS issues important information for provider regarding the billing of hospital outpatient and inpatient ancillary services

On February 24, CMS sent a notice to providers about claims inappropriately overlapping when billed with a 12X and 13X type of bill with the same date of service. See below: 

The Centers for Medicare & Medicaid Services (CMS) has identified a Medicare claims processing issue that is causing certain hospital outpatient services rendered in an institutional setting to be processed incorrectly. 

Medicare contractors have been instructed to not reject claims with Reason Codes 38038, 38074, 38151, 38033, and 38154 when the discharge date of the outpatient claim (13X) is the same as the admission date of the inpatient ancillary claim (12X).  If your claims have rejected with the above reason codes in error, you can now begin resubmitting claims.

 

CMS issues guidance on requirements for ordering hospital outpatient services

On February 17, CMS issued a certification letter that clarifies the requirements for who is authorized to order hospital outpatient services. CMS states that Outpatient services in hospitals may be ordered (and patients may be referred for hospital outpatient services) by a practitioner who is responsible for the care of the patient; licensed in, or holds a license recognized in the jurisdiction where he/she sees the patient; acting within his/her scope of practice under State law; and authorized by the medical staff to order the applicable outpatient services under a written hospital policy that is approved by the governing body.

View the certification letter
 

CMS announces new audits of Medicare Advantage contracts

On February 24, CMS issued a press release to announce that it is moving forward with a new audits of Medicare Advantage contracts to reduce the payment error rate. CMS estimates the audits will recover an estimated $370 million in overpayments for the first audit year. 

View the press release
 

CMS posts new FAQs about the EHR Incentive Program

CMS has posted a new set of FAQs on the Medicare Electronic Health Record (EHR) Incentive Program including the following:

 

OIG posts review of same-day readmissions at Thomas Jefferson University Hospitals (PA)

On February 23, the OIG posted a report that reviews same-day readmissions at Thomas Jefferson University Hospitals, Inc., located in Philadelphia. For four of the 133 same-day readmissions in the OIG’s review, Jefferson incorrectly billed the second admission as a separate inpatient stay instead of a continuous stay based on the first admission, resulting in $43,000 in overpayments.

View the full report



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