Revenue Cycle

Important Medicare updates

Medicare Update for CAHs, August 24, 2011

CMS posts telemedicine survey letter

CMS issued a survey and certification letter regarding telemedicine services in hospitals and CAHs. The letter discusses new and amended rules effective July 5 that permit hospitals and CAHs to provide telemedicine services to their patients through written agreements with a distant-site hospital or a distant-site telemedicine entity.

View the letter.

CMS issues MUE guidance

On August 12, CMS issued a transmittal to give instructions regarding medically unlikely edits (MUE). In the business requirements of the transmittal, CMS instructed shared systems maintainers to allow a value of “0” units to be assigned to an MUE. CMS is making this change to account for 25 codes that have been discontinued plus any codes for services that Medicare does not cover or discontinues coverage. CMS also provides further clarification and explanation of the MUEs in this transmittal.

Effective date: The effective date for MCS is January 1, 2012, and the effective date for VMS is April 1, 2012. FISS has already met the requirements for this CR.
Implementation date: The implementation date for MCS is January 3, 2012, and the implementation date for VMS is April 2, 2012. FISS has already met the requirements for this CR.

View the transmittal.

CMS instructs on quarterly NCCI update

CMS issued a transmittal to instruct contractors regarding the upcoming quarterly update of the NCCI edit files.

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

View the transmittal.

View a related MLN Matters article.

CMS updates CWF edits for pulmonary rehab, cardiac rehab

On August 5, CMS issued a transmittal to update common working file (CWF) edits regarding pulmonary rehab, cardiac rehab, and intensive cardiac rehab. This will allow institutional and professional providers to bill 36 sessions of cardiac rehabilitation services, without the KX modifier, over a period of 36 weeks.

In addition, this transmittal allows institutional and professional providers to bill 72 sessions of intensive cardiac rehabilitation, without the KX modifier over a period of 18 weeks. The transmittal updates CWF editing to allow institutional and professional providers to bill 36 sessions of pulmonary rehabilitation services, without the KX modifier, over a period of 36 weeks.

Effective date: January 1, 2010 for claims with dates of service on or after January 1, 2010 processed on or after January 3, 2012
Implementation date: January 3, 2012

View the transmittal.

CMS clarifies payment for anesthesiologist services in Method II CAH

On August 1, CMS issued a transmittal to clarify the payment calculation for anesthesia services performed by an anesthesiologist in a Method II CAH.

Effective date: January 1, 2008
Implementation date: January 3, 2012

View the transmittal.

View a related MLN Matters article.

CMS posts IPPS final rule for FY 2012

CMS released a display copy of the IPPS final rule for fiscal year (FY) 2012. CMS says it will publish the final rule in the Federal Register soon. Critical access hospitals that own and operate an ambulance service should review the final rule for changes to the reimbursement methodology.

View the display copy of the IPPS final rule.

View a related press release.

View a related fact sheet.

CMS instructs on RAC demand letters

On July 29, CMS issued a transmittal to shift responsibility for issuance of demand letters from the RACs to the MACs. CMS wishes to increase the efficiency of this process.

Effective date: January 1, 2012
Implementation date: January 3, 2012

View the transmittal.

View a related MLN Matters article.

View a related HCPro article.

Most Popular