Revenue Cycle

Important Medicare updates

Medicare Update for CAHs, February 8, 2012

CMS allows physician assistants to perform SNF level of care certifications

 On January 13, CMS published a pair of transmittals that revise Chapter 8, section 40.1 of the Medicare Benefit Policy Manual to add physician assistants to the list of practitioners that can perform the required initial certification and periodic recertifications of the need for skilled nursing facility (SNF) level of care. 

Effective Date: Effective with items and services furnished on or after January 1, 2011, consistent with section 3108 of the Affordable Care Act.

Implementation Date: February 13, 2012

View the Benefit Policy transmittal 

View the Medicare General Information, Eligibility, and Entitlement transmittal

CMS updates the CCI edits

On January 13, CMS published the quarterly updates to the correct coding initiative (CCI) edits. 

Effective Date: April 1, 2012

Implementation Date: April 2, 2012

View the transmittal

CMS replaces MPFS transmittal to revise summary of the multiple procedure payment reduction

On January 18, CMS rescinded Transmittal 2369, dated December 16, 2011, and replaced by it with Transmittal 2379 to revise the summary of the multiple procedure payment reduction and revisions to the practice expense geographic adjustment policies described in Section B of the Recurring Update Notification.

Effective Date: January 1, 2012

Implementation Date: January 3, 2012

View the transmittal

CMS covers sexually transmitted infection screenings

On January 26, CMS issued a pair of transmittals that state it will cover screening for Chlamydia, gonorrhea, syphilis, and hepatitis B with the appropriate FDA-approved lab tests used consistent with FDA-approved labeling and in compliance with Clinical Laboratory Improvement Amendments (CLIA) regulations. The screenings must be ordered by a primary care provider and performed by an eligible Medicare provider for these services.

Effective Date: November 8, 2011

Implementation Date: February 27, 2012 - Non-shared system edits, July 2, 2012 – Shared system edits, CWF Provider Screen, HICR, and MCSDT Changes

View the claims processing transmittal 

View the national coverage determination transmittal

CMS creates new edits to correct improper payments identified by recovery auditors

On January 26, CMS issued a transmittal that states it created edits to correct improper payments that have been identified by the recovery auditors. Edits installed for these issues include: claims related to pulmonary diagnostic procedures, IV hydration procedures, not a new patient, and global day surgery procedures.

View the transmittal

 CMS updates the list of codes exempt from POA reporting

On January 25, CMS issued a transmittal that lists ICD-9-CM codes that have either been added to or deleted from the list of diagnosis codes exempt from reporting a present on admission (POA) indicator effective October 1, 2011.

Effective Date: October 1, 2011

Implementation Date: July 2, 2012 

View the transmittal

CMS clarifies billing instructions related to LTR days

On January 20, CMS issued a transmittal that clarifies billing instructions in the Medicare Claims Processing Manual, Chapter 3, Inpatient Hospital Billing, Section 40, Billing Coverage and Utilization Rules for PPS and Non-PPS Hospitals when life time reserve (LTR) days exhaust during the nonoutlier portion of an Inpatient Prospective Payment System (IPPS) stay.

View the transmittal

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