Corporate Compliance

Other CMS and OIG Issuances

Medicare Insider, August 14, 2007

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CMS Frequently Asked Questions

CMS issued/updated the following FAQs last week (the questions are reprinted verbatim from the CMS web site):

  • When there is an interrupted stay during an Inpatient Psychiatric Facility (IPF) visit, can an IPF bill two claims? (view)

  • Can an Inpatient Psychiatric Facility (IPF) use the alcohol or substance abuse diagnosis as its principal diagnosis even for a patient that came to its hospital for a different reason? (view)

  • Under the acute care hospital Inpatient Prospective Payment System (IPPS), a hospital must submit an adjustment bill (XX7) for adjusting diagnoses codes with 60-days from the original claim's date of payment. Does the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) require Inpatient Psychiatric Facilities (IPFs) to follow the 60-day timeframe for submitting adjustment bills (XX7) on diagnoses codes? (view)
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  • Will Medicare pay for the implantation of a conventional IOL to replace a presbyopia-correcting IOL that was implanted subsequent to removal of the beneficiary's cataractous lens, if he experiences complications with the presbyopia-correcting lens? (view)

    The ruling states that the "beneficiary is responsible for payment of the portion of the facility charge that exceeds the facility charge for insertion of a conventional IOL following cataract surgery."

    The question has been raised as to whether CMS meant "charge" as this term of art is generally considered-i.e., does the statement mean the patient is responsible to pay the difference between the ASC's or HOPD's charge (not cost) for the presbyopia-correcting IOL. Assuming charge is the answer, how would "standard and customary charges" be established? (view)

  • Explain calculating the cost-to-charge ratio for the [IPF] facility versus the cost-to-charge ratio for each cost center. (view)

  • Are there any CMS regulations that require Inpatient Psychiatric Facilities (IPFs) to have daily Medical Director (MD) notes? (view)

  • Who is responsible for billing for Emergency Department (ED) services when the patient is discharged from an Inpatient Psychiatric Facility (IPF) to the emergency room and returns to the IPF within the same day? (view)

  • For Inpatient Psychiatric Facilities (IPFs) that split billed at the end of the calendar year under Tax Equity & Fiscal Responsibility Act of 1982 (TEFRA), but are now required to cancel these bills and resubmit to the Fiscal Intermediary (FI) one claim that covers the entire stay under the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS), will the corrected claims be subject to the payment floor (a mandatory 14-day hold)? (view)

  • Will the 190-day lifetime maximum still apply under the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS)? (view)

  • If the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) payment issued to our IPF is less than our Tax Equity & Fiscal Responsibility Act of 1982 (TEFRA) reimbursement, may our facility bill the patient for the difference? (view)

  • What is Medicare's policy on a provider's treatment on the Medicare cost report of discounts, allowances, rebates, and refunds from vendors or from GPOs? (view)


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