Revenue Cycle

Important Medicare updates

Medicare Update for CAHs, July 13, 2011

CMS issues OPPS proposed rule

On July 1, CMS issued a proposed rule that would update payment policies and rates for both hospital outpatient departments and ambulatory surgical centers for calendar year 2012.

View the proposed rule.

View a related fact sheet.

CMS advises on conflicting documentation

CMS has issued a special MLN Matters article on DRG coding vulnerabilities for inpatient hospitals. Although CAHs are not paid for inpatient services under the DRG system for Medicare patients, the coding guidelines are the same for both PPS and cost-based reimbursement. 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. Critical access hospitals that have distinct part units to provide inpatient psychiatric and inpatient rehabilitation services should be aware of the correction.

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

View the transmittal.

CMS posts new waived tests

CMS 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 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.

CMS issues quarterly OCE update

CMS posted the quarterly update specifications for the outpatient code editor (OCE).

View the summary of changes.

View the final specifications.

CMS creates new manual

CMS created a new manual, publication 100-11, entitled Programs of All-Inclusive Care for the Elderly (PACE) Manual.

View the new manual chapters.

CMS posts lab requisitions proposed rule  

On June 30, CMS issued a proposed rule that would rescind the requirement it adopted in its recent 2011 final rule under the physician fee schedule that for lab requisitions to have physician signatures.

View the proposed rule.

Read more about CMS’ proposal.

CMS reorganizes Program Integrity Manual

On May 27, CMS announced that it will relocate and delete sections of Chapter 3 of the Program Integrity Manual for better flow of information and ease of use. Some of the sections in Chapter 3 will be moved to a new Chapter 8. These changes manualize previous CMS instructions on signature requirements, medical record late entries, pre-payment and post-payment review guidelines and additional documentation requests (ADR). All providers should review these changes to understand how they will affect their individual facilities claims review process in relation to their compliance efforts. 

Effective date: June 28, 2011
Implementation date: June 28, 2011

View transmittal R377PI.

Relevant upcoming open door forums

The next Physician, Nurses and Allied Health Professionals Open Door Forum is scheduled for Tuesday, August 9, 2011 from 2 p.m. to 3 p.m. ET. To participate, dial 1-800-837-1935 conference ID 68641515.

Click here for more information.

Most Popular