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Medicare Update for CAHs
Medicare Update for CAHs is a free bi-weekly ezxne that provides specialized information for our CAH (critical access hospital) customers, focusing on reimbursement and CMS updates that are important for CAHs.
2012
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2011
Issue 2, March 21, 2012
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Scenario: Benefit period for a hospital/SNF patient stay
Question: A Medicare beneficiary who had never before been hospitalized was admitted to and stayed...
Issue 2, February 22, 2012
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Important Medicare updates
CMS corrects 2012 payment rate increases for RHCs and FQHCs -
Recent recovery auditor activity
DCS Healthcare posts new issue for DME supplier claims -
Recent RAC activity
DCS Healthcare posts 54 new issues across two categories
Issue 1, January 11, 2012
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CMS to delay two of out three new demonstration projects aimed at reducing improper payments
On December 29, CMS issued a notice announcing the delay of the recovery audit prepayment review...
Issue 24, November 28, 2012
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Notice: Your subscription will be changing in the coming weeks!
Very shortly, Medicare Update for CAHs will be replaced with Medicare Insider. -
Focus on CAHs: 2013 OIG Work Plan
The Office of Inspector General (OIG) for the U.S. Department of Health & Human Services (HHS... -
Important Medicare updates
CMS issues press release on ACA impact on payments to primary care physicians
Issue 23, November 14, 2012
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A clarification on billing for CAH swing bed services
Editors note: This article was written by Debbie Mackaman, RHIA, CHCO, regulatory specialist for... -
Important Medicare Updates
CMS issues corrections to EHR incentive program – Stage 2 final rule -
Recent Recovery Auditor activity
HealthDataInsights posts two new issues for outpatient hospital claims
Issue 22, October 31, 2012
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Important Medicare updates
CMS issues press release on 2013 quality ratings for Medicare health and drug plans -
True or false quiz: Billing for CT scan during a swing bed stay
Normal 0 false false false EN-US X-NONE X-NONE...
Issue 21, October 17, 2012
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CMS issues next wave of supervision decisions on Hospital Outpatient Payment Panel
Earlier this year, CMS held its first Hospital Outpatient Payment Panel meeting, which managed to... -
Important Medicare Updates
CMS issues preliminary decisions on recommendations of outpatient payment panel on supervision... -
Quiz: Billing for an emergency room visit with extensive nursing care
A Medicare beneficiary was seen in the hospital emergency department and required extensive nursing... -
Recent Recovery Auditor Activity
HealthDataInsights posts two new issues across two categories, including first prepayment review... -
Reboot for ICD-10-Training and Operational Readiness Checklist for 2013
With the implementation deadline confirmed, the transition to ICD-10 shifts into high gear.
Issue 20, October 3, 2012
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CMS policies and conversion from ICD-9 to ICD-10
It was a rather quiet week last week as CMS and the Medicare contractors, including providers, get... -
Important Medicare updates
CMS issues press release on Affordable Care Act -
Does your CAH have a CDI program in place?
Does you critical access hospital perform concurrent medical record reviews to ensure the physician...
Issue 19, September 19, 2012
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CAH perspective: CMS' proposal to redefine inpatient
Editor’s note: On August 23, HCPro released an article that outlines a request that CMS made... -
Important Medicare updates
CMS issues administrative simplification final rule
Issue 18, September 5, 2012
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Double trouble: DRG 312 to be reviewed prepayment and postpayment?
Following the announcement of the official start date of prepayment reviews (set to begin August... -
Important Medicare updates
CMS announces Stage 2 final rule for Medicare and Medicaid EHR Incentive Programs -
Recovery Auditor prepayment review ODF transcript and audio
The transcript & audio file from the August 9, 2012 Medicare Fee-For-Service Recovery Auditor...
Issue 17, August 22, 2012
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CMS issues payment methodology for global surgical split care submitted with Modifier -54 and/or -55 for CAH Method II providers
On August 3, CMS issued a transmittal and accompanying MLN Matters article that providers... -
Important Medicare Updates
CMS issues interim final rule for healthcare EFT and RA transactions -
MCF 2012 audio spotlight: Major news in OPPS proposed rule
In the recently released 2013 OPPS proposed rule, CMS issued a request for comments that suggests...
Issue 16, August 8, 2012
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Physician supervision enforcement for CAHs: Part 2
In addition to proposing to extend the non-enforcement of supervision rules for critical access... -
Important Medicare updates
CMS announces two website redesigns -
Free tool: Level of care pocket card: Outpatient surgery and observation
Download this pocket card to use as a helpful tool that provides important “points to... -
Recent Recovery Auditor activity
DCS Healthcare posts new issue for DME claims
Issue 15, July 25, 2012
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Physician supervision enforcement for CAHs: Part 1
On July 6, CMS released a display copy of the 2013 OPPS proposed rule. -
Important Medicare updates
CMS issues three-day payment window FAQs -
CMS proposes two significant changes for OPPS in 2013
CMS is proposing two major changes as part of the 2013 OPPS proposed rule, released July 6. -
Recent Recovery Auditor activity
CGI posts four new issues for physician claims
Issue 14, July 11, 2012
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Recovery auditor prepayment reviews: CAH impact and more
Last November, CMS unveiled three demonstration projects aimed at reducing improper payments in the... -
Important Medicare updates
CMS instructs on provider self audits -
Scenario: CAH staffing requirements
Dr. Anderson is a physician that covers the emergency department of a critical access hospital... -
Recent Recovery Auditor activity
CGI posts new issue for outpatient claims
Issue 13, June 27, 2012
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July OPPS update: Self-administered drugs
Last week, the Medicare Weekly Update provided an overview of the many significant updates and... -
Important Medicare updates
CMS issues July 2012 OPPS update -
Scenario: Lab test coverage
A physician ordered a bacterial urine culture (87086) for a Medicare patient from the...
Issue 12, June 13, 2012
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Important Medicare updates
CMS instructs record requests related to the claim being reviewed -
CMS publishes improper payment figures and appeals statistics
In the last month, CMS posted two separate sets of data that provide nationwide statistics on its... -
Recent Recovery Auditor activity
DCS Healthcare posts ten new issues across six categories -
Recent Recovery Auditor activity
HealthDataInsights posts seven new issues across three categories
Issue 11, May 30, 2012
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CMS revises Medicare Conditions of Participation for hospitals and CAHs
On May 9, CMS released two rules aimed at reducing regulatory burdens for healthcare providers. -
Important Medicare Updates
CMS releases 2013 IPPS proposed rule -
CMS identifies CERT, Recovery Auditor findings in latest quarterly compliance newsletter
Last month CMS released the seventh issue of its Medicare Quarterly Provider Compliance Newsletter.
Issue 10, May 16, 2012
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CMS instructs on payment methodology for anesthesiology claims submitted with a -GC modifier
On April 26, CMS issued transmittal R2452CP that implements the payment methodology for... -
Important Medicare updates
CMS issues guidance on determining rural location for swing bed and RHC eligibility -
Scenario: Billing for a Medicare patient's hernia repair
Situation: Jonathan, a 68-year-old Medicare patient, presents to a hospital’s outpatient... -
Recent Recovery Auditor Activity
DCS Healthcare posts one new issue into two categories
Issue 9, May 2, 2012
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Heads up: Contractors holding Method II 85X claims with modifier -22
On April 19, CMS sent out an e-mail notification regarding critical access hospitals (CAHs) that... -
Important Medicare updates
CMS continues updates to Program Integrity Manual -
Scenario: Billing diagnostic services on a swing bed claim
A patient was in a covered CAH swing bed stay receiving skilled nursing services for complications... -
Recent Recovery Auditor Activity
DCS Healthcare posts nine new issues across four categories
Issue 8, April 18, 2012
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CMS system update to allow correct NPI reporting for PCIP for CAHs reimbursed under optional method
Earlier this year CMS released a transmittal that implements a system update to include the... -
Important Medicare updates
CMS revises "incident to" transmittal -
Scenario: Calculating a patient's coinsurance amount at a Method I CAH
Question: If a hospital charges $1,000 for an outpatient procedure and the cost of the procedure... -
Recent Recovery Auditor activity
DCS Healthcare posts two new issues for skilled nursing facility claims
Issue 7, April 4, 2012
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Recovery auditor hot topic: Medicaid RACs
Since Medicaid RACs officially launched on the first day of 2012, there hasn?t been much news... -
Important Medicare updates
CMS redesigns claims and benefits statement -
From the field: CMS Q&A on the discussion period
After reading about another provider’s Recovery Auditor correspondence woes in a February 23... -
Recent Recovery Auditor activity
DCS Healthcare posts new issue for medical necessity claims
Issue 6, March 21, 2012
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CAHs take notice: Certain improper payment edits required by July 1
CMS recently released two replacement transmittals that summarize Recovery Auditor-identified... -
Important Medicare updates
OIG posts review of Medicare outpatient billing for selected drugs at NorthBay Medical Center (CA)
Issue 5, March 7, 2012
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CMS issues guidance on place of service coding instructions
On February 3, CMS issued a transmittal that revises and clarifies the national policy for place of... -
Important Medicare updates
HHS announces intent to delay ICD-10 compliance date -
CMS posts year-end improper payment figures, top issues by region
On February 9, CMS posted its latest recovery auditor update. The results show a continuing trend... -
Recent recovery auditor activity
HealthDataInsights posts seven new issues for medical necessity claims
Issue 4, February 22, 2012
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Q&A with Debbie Mackaman: Recovery auditors and more
What type of impact do you think the newly announced demonstration project for recovery auditor...
Issue 3, February 8, 2012
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MPPR to apply for certain diagnostic imaging procedures for Method II CAHs
On January 26, CMS issued a transmittal that implements the multiple procedure payment reduction... -
Important Medicare updates
CMS allows physician assistants to perform SNF level of care certifications -
Inside a CAH's IT decision-making process
Steven L. Kelley, president and CEO of Ellenville (NY) Regional Hospital admits that he’s a... -
Recent RAC activity
HealthDataInsights posts 33 new issues for medical necessity claims -
Start date announced for recovery audit prepayment review demo
On November 15, 2011, CMS unveiled three demonstration projects aimed at reducing improper payments...
Issue 2, January 25, 2012
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Peeling away the confusion: Split billing guidance
The concept of split billing in both the inpatient and outpatient setting is a hot topic amongst... -
Important Medicare updates
CMS updates NCDs CMS posted a new version of the lab NCD manual for the first quarter -
Confusing the rebuttal process with the discussion period
The following question and answer is an exchange between a reader and the Revenue Cycle Institute... -
Recent RAC activity
DCS Healthcare posts 25 new issues for medical necessity claims
Issue 1, January 11, 2012
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CMS announces RHC and FQHC payment rate increases for 2012
In early November, CMS issued a transmittal that provides the payment rate increases for rural... -
Important Medicare updates
CMS creates CO-OP program to expand health plans -
Scenario: Physical therapy treatments billing
A patient undergoes physical therapy treatments on January 1 and 6. A CT scan, not a supporting... -
CMS releases details of recovery auditor prepayment review demonstration
On November 15, CMS announced that it will launch a number of demonstration programs starting in...