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Medicare Weekly Update
Each issue of Medicare Weekly Update includes the latest CMS proposed and final rules, CMS manual revisions, and transmittals. Readers also find OIG audit reports, advisory opinions, and more.Medicare Weekly Update
Issue 53, December 30, 2008
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Where to go to get your laboratory NCD information
This week, CMS published the laboratory Medicare National Coverage Determinations Coding Policy... -
Regulations: CMS grants waivers from CLIA requirements
On December 22, CMS published in the Federal Register a notice announcing it has granted exemptions... -
Transmittals: CMS maintains PTA NCD, updates cost report form and instructions
On December 24, CMS issued a transmittal maintaining its current NCD for PTA of the carotid artery... -
Other Issuances: CMS updates lab NCD manual, OIG issues adverse events case study, and more
CMS has released its January 2009 update to the NCD manual for clinical diagnostic laboratory... -
CMS Public Events
CMS has no public events scheduled for this week.
Issue 52, December 23, 2008
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NP/PA supervision in provider-based departments
I thought I would do a follow-up to Hugh’s note last week about physician supervision. One of... -
Regulations: No issuances this week
CMS issued no significant regulations affecting hospital billing this week. -
Transmittals: CMS announces new waived tests, updates clotting factor furnishing fee, and more
On December 19, CMS issued its annual update to the furnishing fee for clotting factor. -
Other Issuances: CMS updates serum iron studies NCD, OIG publishes safe harbor notice, and more
On December 18, CMS extended coverage under the serum iron studies NCD to ICD-9-CM codes 285.22 and... -
CMS Public Events
CMS has no public events scheduled for this week.
Issue 51, December 16, 2008
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Physician supervision for on-campus provider-based departments
A colleague (another healthcare lawyer) contacted me last week to talk about CMS’s discussion... -
Regulations: No issuances this week
CMS issued no significant regulations affecting hospital billing this week. -
Transmittals: CMS rejects TIPs coverage, implements changes to medical necessity edits for lab services
On December 12, CMS updated its Program Integrity Manual to reflect recent changes to its... -
Other Issuances: CMS updates frequently asked questions, issues decision memo; OIG issues reports
On December 12, CMS issued 125 new/updated frequently asked questions related to Medicare... -
CMS Public Events
CMS has no public events scheduled for this week.
Issue 50, December 9, 2008
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OPPS outlier reconciliation and recoupment starts in 2009
This week, the OIG published the fiscal year (FY) 2007 annual report for the Health Care Fraud and... -
Regulations: CMS publishes revised final wage indices and hospital reclassifications
On December 3, CMS published in the Federal Register revised final wage indices and hospital... -
Transmittals: CMS issues new MAC numbers, updates SOM exhibits
On November 28, CMS released a transmittal assigning new numbers for all MAC jurisdictions. -
Other Issuances: CMS proposes NCDs for surgical never events, OIG issues Semiannual Report, and more
On December 3, the OIG issued its Semiannual Report to Congress for April 1–September 30 of... -
CMS Public Events: HAC listening session
CMS has scheduled a listening session on hospital-acquired conditions (HAC) in inpatient and...
Issue 49, December 2, 2008
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CMS issues guidance on the effect of POA indicators for HACs
CMS issued a Special Edition MLN Matters article last week on the present-on-admission indicator... -
Regulations: No issuances this week
CMS Regulations -
Transmittals and MLN Matters: CMS releases special edition MLN Matters article
On November 24, CMS issued a special edition MLN Matters article. -
Other Issuances: OIG releases reports on high-dollar payments, CMS issues PT test decision memo, and more
On November 25, the OIG issued a report on high-dollar outpatient claims processed by Cahaba... -
CMS Public Events
CMS Public Events this Week
Issue 48, November 25, 2008
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Preparing for an A/B MAC transition
This week, CMS announced National Heritage Insurance Company (NHIC) as the A/B MAC for the New... -
Regulations: CMS publishes 2009 OPPS final rule
On November 18, CMS published the CY 2009 OPPS final rule in the Federal Register. As reported in... -
Transmittals and MLN Matters articles: CMS corrects previous issuance, releases article on telehealth services
On November 17, CMS rescinded and replaced its November 7 transmittal updating the Medicare... -
Other Issuances: CMS updates FAQs, OIG issues report on Medicare billing for oxaliplatin, and more
On November 21, CMS issued 41 new/updated frequently asked questions related to Medicare... -
CMS Public Events
CMS Public Events this Week
Issue 47, November 18, 2008
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Strategies for tackling the 2009 OPPS final rule
By now, many of you may have started to look over the display copy of the 2009 OPPS final rule... -
Regulations: No issuances this week
CMS issued no significant regulations affecting hospital billing this week. -
Transmittals and MLN Matters articles: CMS updates IPPE benefit, issues MLN Matters articles, and more
On November 14, CMS issued two transmittals adding certain entities as originating sites for... -
Other Issuances: None released this week
Neither CMS nor the OIG released any other significant issuances this week affecting coverage... -
CMS Public Events
CMS Public Events this Week
Issue 46, November 13, 2008
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Correction: CMS Public Events
The next CMS Hospital & Hospital Quality Open Door Forum conference call is scheduled for...
Issue 45, November 11, 2008
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CMS corrects definitions of non-selective angiography codes
In 2003, CMS published revised definitions for two codes (G0275 and G0278), which describe... -
Regulations: No issuances this week
CMS issued no significant regulations affecting hospital billing this week. -
Transmittals: CMS issues HCPCS update, updates therapy code list, and more
On November 7, CMS issued a transmittal implementing an update to HCPCS for 2009. -
Other Issuances: OIG releases reports on DSH payments, oxaliplatin billing
On November 7, the OIG issued a report on DSH capital payments for the period October 1, 2000... -
CMS Public Events: ODF call scheduled for November 17
The next CMS Hospital & Hospital Quality Open Door Forum conference call is scheduled for...
Issue 44, November 4, 2008
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CMS releases 2009 OPPS final rule display copy
The big news last week was the release of the display copy of 2009 OPPS final rule. The display... -
Regulations: CMS issues display copy of 2009 OPPS final rule
On October 30, CMS released a display copy of the CY 2009 OPPS final rule. CMS also released... -
Transmittals: Error on CMS Web site
Due to an error with the CMS Web site, transmittals issued last week were inaccessible before... -
Other Issuances: OIG issues review of HIPAA security enforcement, reports on high-dollar payments
On October 30, the OIG issued a review of CMS’ oversight of the HIPAA security rule. The OIG... -
CMS Public Events
CMS has no public events scheduled for this week.
Issue 43, October 28, 2008
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Are hospitals improperly converting inpatient cases to observation?
It was recently brought to my attention that some (perhaps many) hospitals may be using the... -
Regulations: No issuances this week
CMS issued no significant regulations affecting hospital billing this week. -
Transmittals: CMS implements CWF edits, changes interpretive guidelines for hospital conditions of participation, and more
On October 24, CMS issued a transmittal recognizing four authoritative compendia for use in... -
Other Issuances: CMS clarifies guidance on standing orders, OIG releases report on high-dollar claims, and more
On October 24, CMS issued a memo clarifying the use of standing orders in hospitals and the... -
CMS Public Events
CMS has no public events scheduled for this week.
Issue 42, October 21, 2008
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Watch for potential RAC trickle-down effect
I taught a Medicare course in Chicago last week. One of the course participants from California... -
Regulations: No issuances this week
CMS issued no significant regulations affecting hospital billing this week. -
Transmittals: CMS updates interest rate for Medicare overpayments and underpayments, clarifies previous transmittal on CPAP therapy for OSA
On October 15, CMS issued a transmittal instructing Medicare contractors to implement an interest... -
Other Issuances: CMS issues decision memo on PTA, OIG reviews high-dollar payments
On October 16, the OIG issued a report on high-dollar payments for inpatient and outpatient claims... -
CMS Public Events
CMS has no public events scheduled for this week.
Issue 41, October 14, 2008
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CMS Public Events
CMS has no public events scheduled for this week. -
Other Issuances: CMS announces RAC selections, OIG issues report on high-dollar claims, and more
On October 6, CMS issued a press release and fact sheet discussing various CMS efforts underway to... -
MLN Matters articles: CMS issues articles on lab NCD edits, FY 2009 IPPS changes
CMS released two MLN Matters articles last week related to transmittals previously announced in... -
Regulations: CMS revises definition of "multiple source drug"
On October 7, CMS published a final rule in the Federal Register revising the definition of... -
Four claim RACs announced
The big news last week was the announcement of the four Claim RACs (i.e., claim review contractors...
Issue 40, October 7, 2008
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Busy week: OIG Work Plan, CMS' MUE list available
There were a number of significant regulatory developments last week, including the release of the... -
Regulations: CMS issues wage indices, payment rates, and corrections for 2009 IPPS
On October 3, CMS published in the Federal Register a notice providing the wage indices, hospital... -
Transmittals and MLN Matters articles: CMS updates IPPS, lab NCDs, and more
On October 3, CMS issued a transmittal implementing FY 2009 changes for IPPS hospitals. The... -
Other Issuances: CMS publishes MUEs, OIG issues annual Work Plan, and more
On October 3, the OIG released a report on high-dollar payments that National Government Services... -
CMS Public Events: ODF scheduled for October 9
The next CMS Hospital & Hospital Quality Open Door Forum conference call is scheduled for...
Issue 39, September 30, 2008
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CMS conference call addresses ICD-10
The details of the transition to ICD-10 are obviously critically important to hospitals. In order... -
Regulations: CMS publishes final rule on termination of non-random prepayment complex medical review
On September 26, CMS published in the Federal Register a final rule setting forth the criteria CMS... -
MLN Matters articles: CMS releases articles on OPPS, OCE updates
CMS released two MLN Matters articles last week related to transmittals previously announced in... -
Other Issuances: CMS revises heart-related NCDs, announces 2009 deductible and coinsurance amounts
On September 26, CMS issued two revised NCDs, one for heart transplants and one for artificial... -
CMS Public Events
CMS has no public events scheduled for this week.
Issue 38, September 23, 2008
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Review the latest OPPS update
CMS issued the October OPPS update last week. As always, hospitals should review this update in... -
Regulations: No issuances this week
CMS issued no significant regulations affecting hospital billing this week. -
Transmittals and MLN Matters articles: CMS issues OPPS, NCCI updates, and more
On September 19, CMS released the fourth quarter update to the NCCI edits. -
Other Issuances: OIG issues report on high-dollar payments
On September 15, the OIG issued a report on high-dollar payments for inpatient services processed... -
CMS Public Events
CMS has no public events scheduled for this week.
Issue 37, September 16, 2008
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Revenue code edit in the OCE?
As you can see by the number of items reported below, CMS was busy last week. One of the documents... -
Regulations: CMS publishes IRF PPS correction
On September 12, CMS published in the Federal Register a correction to the IRF PPS. The correction... -
Transmittals and MLN Matters articles: CMS updates OCE, ASP drug pricing files, and more
On September 12, CMS rescinded its May 20, 2008, transmittal (Change Request 6012) regarding the... -
Other Issuances: CMS selects MAC, OIG issues report on IPF transition claims, and more
On September 12, CMS released a memo announcing that Mike Leavitt, secretary of HHS, declared a... -
CMS Public Events
CMS has no public events scheduled for this week.
Issue 36, September 9, 2008
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New guidance on ABNs
The big news this week is the release of Change Request 6136. CR 6136 is the long awaited... -
Regulations: No issuances this week
CMS issued no significant regulations affecting hospital billing this week. -
Transmittals and MLN Matters articles: CMS issues revised ABN instructions, physician signature article, and more
On September 5, CMS released revised manual instructions on limitation on liability, including use... -
Other Issuances: CMS releases memo on drug or alcohol screening/testing and CLIA certification
On September 5, CMS released a memorandum in which it restated its policy that laboratories... -
CMS Public Events
CMS has no public events scheduled for this week.
Issue 35, September 3, 2008
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CMS issues transmittal on physician signature requirements
As reported below, CMS issued a transmittal last week (Change Request 6100) updating Section 80.6.1... -
Regulations: HHS publishes ICD-10, HIPAA transactions proposed rules, and more
On August 22, HHS published the ICD-10 proposed rule in the Federal Register. As reported in the... -
Transmittals: CMS implements artificial heart NCD, clarifies physician signature requirements, and more
On August 29, CMS issued two transmittals implementing its May 1 NCD that established coverage for... -
Other Issuances: CMS updates FAQs, OIG issues report on oxaliplatin billing, and more
On August 28 and 29, CMS issued 50 new/updated frequently asked questions related to Medicare... -
CMS Public Events
CMS has no public events scheduled for this week.
Issue 34, August 26, 2008 - VIEW THE FULL ISSUE
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Note from Hugh
Note from Hugh -
CMS Transmittals and MLN Matters articles
CMS Transmittals and MLN Matters articles -
Other CMS and OIG Issuances
Other CMS and OIG Issuances -
CMS Public Events this Week
CMS Public Events this Week
Issue 33, August 19, 2008
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CMS Public Events this Week
CMS has no public events scheduled for this week. -
Other CMS and OIG Issuances
Neither CMS nor the OIG released any other significant issuances this week affecting coverage... -
CMS Transmittals and MLN Matters articles
CMS releases MLN Matters article -
CMS Regulations
On August 15, HHS proposed to adopt the ICD-10-CM and ICD-10-PCS code sets to replace the ICD-9-CM... -
Note from Hugh
Last week was a relatively light week on the regulatory front with one significant...
Issue 32, August 12, 2008
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CMS Public Events
CMS Public Events -
Other CMS and OIG Issuances
Other CMS and OIG Issuances -
CMS Transmittals and MLN Matters articles
CMS Transmittals and MLN Matters articles -
CMS Regulations
CMS Regulations -
Note from Hugh
Note from Hugh
Issue 31, August 5, 2008
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Note from Hugh
Note from Hugh -
CMS Regulations
CMS Regulations -
CMS Transmittals and MLN Matters Articles
CMS Transmittals and MLN Matters Articles -
Other CMS and OIG Issuances
Other CMS and OIG Issuances -
CMS Public Events
CMS Public Events
Issue 30, July 29, 2008
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Note from Hugh
Note from Hugh -
CMS Regulations
CMS Regulations -
CMS Transmittals and MLN Matters articles
CMS Transmittals and MLN Matters articles -
Other CMS and OIG Issuances
Other CMS and OIG Issuances -
CMS Public Events this Week
CMS Public Events this Week
Issue 29, July 22, 2008
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Note from Hugh
Note from Hugh -
CMS Regulations
CMS Regulations -
CMS Transmittals and MLN Matters articles
CMS Transmittals and MLN Matters articles -
Other CMS and OIG Issuances
Other CMS and OIG Issuances -
CMS Public Events this Week
CMS Public Events this Week
Issue 28, July 15, 2008
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Note from Hugh
Note from Hugh -
CMS Regulations
CMS Regulations -
CMS Transmittals and MLN Matters articles
CMS Transmittals and MLN Matters articles -
Other CMS and OIG Issuances
Other CMS and OIG Issuances -
CMS Public Events this Week
CMS Public Events this Week
Issue 27, July 8, 2008
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Note from Hugh
Note from Hugh -
CMS Regulations
CMS Regulations -
CMS Transmittals and MLN Matters articles
CMS Transmittals and MLN Matters articles -
Other CMS and OIG Issuances
Other CMS and OIG Issuances -
CMS Public Events this Week
CMS Public Events this Week
Issue 26, July 1, 2008
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Note from Hugh
Note from Hugh -
CMS Regulations
CMS Regulations -
CMS Transmittals and MLN Matters articles
CMS Transmittals and MLN Matters articles -
Other CMS and OIG Issuances
Other CMS and OIG Issuances -
CMS Public Events this Week
CMS Public Events this Week
Issue 25, June 24, 2008
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Note from Hugh
Note from Hugh -
CMS Regulations
CMS Regulations -
CMS Transmittals and MLN Matters articles
CMS Transmittals and MLN Matters articles -
Other CMS and OIG Issuances
Other CMS and OIG Issuances -
CMS Public Events this Week
CMS Public Events this Week
Issue 24, June 17, 2008
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Note from Hugh
Note from Hugh -
CMS Regulations
CMS Regulations -
CMS Transmittals and MLN Matters articles
CMS Transmittals and MLN Matters articles -
Other CMS and OIG Issuances
Other CMS and OIG Issuances -
CMS Public Events this Week
CMS Public Events this Week
Issue 23, June 10, 2008
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Note from Hugh
Note from Hugh -
CMS Regulations
CMS Regulations -
CMS Transmittals and MLN Matters articles
CMS Transmittals and MLN Matters articles -
Other CMS and OIG Issuances
Other CMS and OIG Issuances -
CMS Public Events this Week
CMS Public Events this Week
Issue 22, June 3, 2008
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Note from Hugh
Note from Hugh -
CMS Transmittals and MLN Matters articles
CMS Transmittals and MLN Matters articles -
CMS Regulations
CMS Regulations -
CMS Public Events this Week
CMS Public Events this Week
Issue 21, May 27, 2008
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Note from Hugh
Note from Hugh -
CMS Regulations
CMS Regulations -
CMS Transmittals and MLN Matters articles
CMS Transmittals and MLN Matters articles -
Other CMS and OIG Issuances
Other CMS and OIG Issuances -
CMS Public Events this Week
CMS Public Events this Week
Issue 20, May 20, 2008
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Note from Hugh
Note from Hugh -
CMS Regulations
CMS Regulations -
CMS Transmittals and MLN Matters articles
CMS Transmittals and MLN Matters articles -
Other CMS and OIG Issuances
Other CMS and OIG Issuances -
CMS Public Events this Week
CMS Public Events this Week
Issue 19, May 14, 2008
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Note from Hugh
Note from Hugh -
CMS Regulations
CMS Regulations -
CMS Transmittals and MLN Matters articles
CMS Transmittals and MLN Matters articles -
Other CMS and OIG Issuances
Other CMS and OIG Issuances. -
CMS Public Events this Week
CMS Public Events this Week
Issue 18, May 6, 2008
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Note from Hugh
Note from Hugh -
CMS Regulations
CMS Regulations -
CMS Transmittals and MLN Matters articles
CMS Transmittals and MLN Matters articles -
Other CMS and OIG Issuances
Other CMS and OIG Issuances -
CMS Public Events this Week
CMS Public Events this Week
Issue 17, April 29, 2008
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Note from Hugh
Note from Hugh -
CMS Regulations
CMS Regulations -
CMS Transmittals and MLN Matters articles
CMS Transmittals and MLN Matters articles -
Other CMS and OIG Issuances
Other CMS and OIG Issuances -
CMS Public Events this Week
CMS Public Events this Week
Issue 16, April 22, 2008
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Note from Hugh
Note from Hugh -
CMS Regulations
CMS Regulations -
CMS Transmittals and MLN Matters articles
CMS Transmittals and MLN Matters articles -
Other CMS and OIG Issuances
Other CMS and OIG Issuances -
CMS Public Events this Week
CMS Public Events this Week
Issue 15, April 15, 2008
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Note from Hugh
Note from Hugh -
CMS Regulations
CMS Regulations -
CMS Transmittals and MLN Matters articles
CMS Transmittals and MLN Matters articles -
Other CMS and OIG Issuances
Other CMS and OIG Issuances -
CMS Public Events this Week
CMS Public Events this Week
Issue 14, April 8, 2008
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Note from Hugh
Note from Hugh -
CMS Regulations
CMS Regulations -
CMS Transmittals and MLN Matters articles
CMS Transmittals and MLN Matters articles -
Other CMS and OIG Issuances
Other CMS and OIG Issuances -
CMS Public Events this Week
CMS Public Events this Week
Issue 13, April 1, 2008
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Note from Hugh
Note from Hugh -
CMS Regulations
CMS Regulations -
CMS Transmittals and MLN Matters articles
CMS Transmittals and MLN Matters articles -
Other CMS and OIG Issuances
Other CMS and OIG Issuances -
CMS Public Events this Week
CMS Public Events this Week
Issue 12, March 25, 2008
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Note from Hugh
Note from Hugh -
CMS Regulations
CMS Regulations -
CMS Transmittals and MLN Matters articles
CMS Transmittals and MLN Matters articles -
Other CMS and OIG Issuances
Other CMS and OIG Issuances -
CMS Public Events this Week
CMS Public Events this Week
Issue 11, March 18, 2008
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HCPro, Inc. launches new logo and tagline as part of its new corporate branding initiative
HCPro, Inc. launches new logo and tagline as part of its new corporate branding initiative -
Note from Hugh
Note from Hugh -
CMS Regulations
CMS Regulations -
CMS Transmittals and MLN Matters articles
CMS Transmittals and MLN Matters articles -
Other CMS and OIG Issuances
Other CMS and OIG Issuances -
CMS Public Events this Week
CMS Public Events this Week
Issue 10, March 11, 2008
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CMS Regulations
CMS issued no significant regulations affecting hospital billing this week. -
Note from Hugh
Note from Hugh -
CMS Transmittals and MLN Matters articles
CMS Transmittals and MLN Matters articles -
Other CMS and OIG Issuances
Other CMS and OIG Issuances -
CMS Public Events this Week
CMS Public Events this Week
Issue 9, March 4, 2008
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Note from Hugh
Note from Hugh -
CMS Regulations
CMS Regulations -
CMS Transmittals and MLN Matters articles
CMS Transmittals and MLN Matters articles -
Other CMS and OIG Issuances
Other CMS and OIG Issuances -
CMS Public Events this Week
CMS Public Events this Week
Issue 8, February 26, 2008
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Note from Hugh
Note from Hugh -
CMS Regulations
CMS Regulations -
CMS Transmittals and MLN Matters articles
CMS Transmittals and MLN Matters articles -
Other CMS and OIG Issuances
Other CMS and OIG Issuances -
CMS Public Events this Week
CMS Public Events this Week
Issue 7, February 19, 2008
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Note from Hugh
Note from Hugh -
CMS Regulations
CMS Regulations -
CMS Transmittals and MLN Matters articles
CMS Transmittals and MLN Matters articles -
Other CMS and OIG Issuances
Other CMS and OIG Issuances -
CMS Public Events this Week
CMS Public Events this Week
Issue 6, February 12, 2008
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Note from Hugh
Note from Hugh -
CMS Regulations
CMS Regulations -
CMS Transmittals and MLN Matters articles
CMS Transmittals and MLN Matters articles -
Other CMS and OIG Issuances
Other CMS and OIG Issuances -
CMS Public Events this Week
CMS Public Events this Week
Issue 5, February 5, 2008
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Note from Hugh
Note from Hugh -
CMS Regulations
CMS Regulations -
CMS Transmittals and MLN Matters articles
CMS Transmittals and MLN Matters articles -
Other CMS and OIG Issuances
Other CMS and OIG Issuances -
CMS Public Events this Week
CMS Public Events this Week
Issue 4, January 29, 2008
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Note from Hugh
Note from Hugh -
CMS Regulations
CMS Regulations -
CMS Transmittals and MLN Matters articles
CMS Transmittals and MLN Matters articles -
Other CMS and OIG Issuances
Other CMS and OIG Issuances -
CMS Public Events this Week
CMS Public Events this Week
Issue 3, January 22, 2008
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Note from Hugh
Note from Hugh -
CMS Public Events this Week
CMS Public Events this Week -
CMS Regulations
CMS Regulations -
CMS Transmittals and MLN Matters articles
CMS Transmittals and MLN Matters articles -
Other CMS and OIG Issuances
Other CMS and OIG Issuances
Issue 2, January 15, 2008
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Note from Hugh
Note from Hugh -
CMS Regulations
CMS Regulations -
CMS Transmittals and MLN Matters articles
CMS Transmittals and MLN Matters articles -
Other CMS and OIG Issuances
Other CMS and OIG Issuances -
CMS Public Events this Week
CMS Public Events this Week
Issue 1, January 8, 2008
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Note from Hugh
Note from Hugh -
CMS Regulations
CMS Regulations -
CMS Transmittals and MLN Matters articles
CMS Transmittals and MLN Matters articles -
Other CMS and OIG Issuances
Other CMS and OIG Issuances -
CMS Public Events this Week
CMS has not announced any public events for this week.