Revenue Cycle

Important Medicare updates

Medicare Update for CAHs, February 22, 2012

CMS corrects 2012 payment rate increases for RHCs and FQHCs

On January 30, CMS rescinded Transmittal 2343 and replaced it with Transmittal 2406 to provide the corrected 2012 payment rate increases for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs). The Medicare Economic Index (MEI) rate that was previously published did not contain the productivity adjustment that CMS always uses to determine the RHC and FQHC upper payment limit. 

Effective Date: January 1, 2012

Implementation Date: January 3, 2012

View the transmittal
 
CMS implements immediate recoupment process

On January 27, CMS issued a transmittal that implements a standard immediate recoupment process. Providers can elect this process to avoid making payment by check and/or avoid the assessment of interest if the immediate recoupment pays the debt in full before day 31. 

Effective Date: July 1, 2012

Implementation Date: July 2, 2012

View the transmittal
 

CMS considers edits to correct common overpayments

On January 27, CMS published a transmittal that names issues that the recovery auditors identified as significant improper payments and require edits to correct. The issues include claims that have physician place of service codes, evaluation and management services during a global period, untimed codes, and hospital transfers.

Effective Date: July 1, 2012

Implementation Date: July 2, 2012 

View the transmittal  

CMS continues to update Chapter 15 of the PIM

On January 26, CMS issued a transmittal that moves the remaining sections of Chapter 10 of the Program Integrity Manual (PIM) into Chapter 15.  

Effective Date: February 27, 2012

Implementation Date: February 27, 2012

View the transmittal 

NUBC approves a new occurrence span code

On January 26, CMS issued a transmittal that announced The National Uniform Billing Committee (NUBC) approved a new occurrence span code on November 16, 2011, with an effective/implementation date of July 1, 2012. Medicare systems shall accept new occurrence span code 81 used to report antepartum days. 

Effective Date: July 1, 2012

Implementation Date: July 2, 2012 

View the transmittal

OIG posts compliance review of Springhill Medical Center (AL)

Springhill Medical Center,  in Mobile, AL, complied with Medicare billing requirements for 165 of the 182 claims the OIG reviewed. However, the hospital did not fully comply with Medicare billing requirements for selected outpatient claims. Specifically, of the 182 claims, 17 outpatient claims included errors, resulting in overpayments totaling $34,000 for calendar years 2008 and 2009.

View the report
 
OIG posts Medicare compliance review of Kendall Regional Medical Center (FL)
 
Kendall Regional Medical Center, in Miami, generally complied with Medicare billing requirements for selected inpatient and outpatient claims. The OIG reviewed 108 claims and found 24 with billing errors resulting in overpayments totaling $90,000 for calendar years 2009 and 2010. Overpayments occurred primarily because the hospital did not have adequate controls to prevent incorrect billing of Medicare claims.
 
View the report

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