Free e-Newsletters

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 | 2011

Issue 2, March 21, 2012

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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...