Revenue Cycle

Important Medicare updates

Medicare Update for CAHs, April 18, 2012

 
CMS revises "incident to" transmittal

On April 4, CMS rescinded Transmittal 2368 dated December 15, 2011, and replaced it with Transmittal 2437. The new transmittal corrects language in Chapter 17, section 20.1.3, paragraph three of the Medicare Claims Processing Manual, specifically it changes the effective date of the flu season from September 1 to August 1 and to changes “this file” to “payment allowance limits.” All other material remains the same.

Effective Date: January 1, 2013

Implementation Date: January 1, 2013 

View the transmittal

CMS proposes one-year delay of ICD-10-CM/PCS

On April 9, CMS released a proposed rule announcing a one-year delay of the implementation of ICD-10-CM/PCS. If finalized, ICD-10 would become effective October 1, 2014.

View the display copy of the proposed rule

View the HCPro article

View the associated fact sheet

View the associated press release

CMS updates additional documentation limits for Recovery Auditors  

On March 12, CMS issued an update that effectively raises the additional documentation requests (ADR) limits for Recovery Auditors. Beginning March 15, 2012, ADR limits will increase to 2% of all claims submitted in the prior calendar year, divided by eight. This represents a 1% increase from 2011. In addition, the maximum number of requests per 45 days is now 400, which is an increase of 100 from last year. Recovery Auditors may request up to 35 records per 45 days from providers whose calculated limit is 34 records or less.

View the update

CMS updates NCDs

CMS has posted a new version of the lab NCD manual for the second quarter.

View the new lab NCD manual.

OIG posts interactive map with Medicaid Fraud Control Unit data

The OIG posted an interactive map of the United States to its website that shows information from each state’s Medicaid Fraud Control Unit including investigations, convictions, recoveries, and expenditures for fiscal year 2011. The OIG also posted a written summary of the statistics. 

View the map 

View the summary

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