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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.

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Medicare Weekly Update

Issue 53, December 29, 2009

• Note: New Medicare Part B Services for 2010

  In the OPPS final rule, it was announced that there would be two new services covered under...

• Regulations: No issuances this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals and MLN Matters articles: CMS issues 2010 lab update, re-issues OPPS update, and more

  On December 21, CMS rescinded and replaced its previous OPPS update transmittal because of an error...

• Other Issuances: Region C RAC updates issues, OIG reviews oxaliplatin

  On December 24, Connolly Healthcare, the RAC for Region C, updated its list of approved audit...

• CMS Public Events: No events this week

  There are no events this week.

Issue 52, December 22, 2009

• Note: Automatic denial of codes billed with -GA modifier

  Judith previously discussed Transmittal R1840CP implementing a new modifier and instructions for...

• Regulations: No issuances this week

  CMS issued no significant regulations affecting hospital billing this week.

• Other Issuances: RAC issues audit update, CMS clarifies anesthesia guidelines, and more

  On December 18, HealthDataInsights, the RAC for Region D, posted three new issues approved for...

• CMS Public Events: No events this week

  There are no events this week.

• MedicareFind tip: How to use the snippet

  An important tool that I hope MedicareFind users are aware of is the snippet. The snippet is that...

• Transmittals and MLN Matters articles: CMS implements kidney disease education coverage, replaces transmittals, and more

  On December 18, CMS issued a transmittal to make changes related to the timeframe for contractors...

Issue 51, December 15, 2009

• Note: CMS issues manual revisions incorporating CY 2010 OPPS final rule changes

  On Friday, CMS issued two transmittals containing manual provisions that incorporate key changes to...

• Regulations: CMS corrects MPFS final rule

  On December 10, CMS published a correction in the Federal Register to the Medicare physician fee...

• Transmittals and MLN Matters articles: CMS updates OPPS, issues MLN Matters articles, and more

  On December 11, CMS issued two transmittals to incorporate OPPS updates into the Benefit Policy...

• Other Issuances: DCS adds audit issue, OIG audits outpatient rehab

  On December 11, DCS Healthcare updated its list of issues approved for auditing under the RAC...

• CMS Public Events: No events this week

  There are no events this week.

Issue 50, December 8, 2009

• Note: RAC DRG validation audits begin

  CMS has approved Connolly Healthcare, the recovery audit contractor (RAC) for Region C, to begin...

• Regulations: No issuances this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals and MLN Matters articles: CMS addresses modifier misuse, implements NCD for FDG PET for cervical cancer, and more

  On December 4, CMS issued a transmittal to instruct contractors on the processing of claims that...

• Other Issuances: Region C RAC posts DRG validation issues, and more

  Connolly Healthcare, the RAC for Region C, has added at least 24 DRG validation issues to its list...

• CMS Public Events: No events this week

  There are no events this week.

• MedicareFind tip: Sizing up a topic

  When you’re researching topics that are new to you, MedicareFind puts a lot of information in...

Issue 49, December 1, 2009

• Note: CMS provides guidance on voluntary use of ABNs

  In a recent transmittal (R1840CP), CMS provides guidance on the voluntary use of ABNs.  ABNs...

• Regulations: CMS publishes MPFS final rule

  On November 25, CMS published in the Federal Register the 2010 MPFS final rule. CMS had previously...

• Transmittals and MLN Matters articles: CMS issues deactivation instructions, MLN Matters articles

  On November 27, CMS issued a transmittal in which it reminded contractors not to issue appeal...

• Other Issuances: Region B RAC updates audit issues

  CGI Federal has added the following item to its list of approved audit issues for Region B.

• CMS Public Events: CMS posts follow-up to HODF question

  On November 23, CMS posted the following on its Web site in response to a question raised at the...

Issue 48, November 24, 2009

• Note: Physician Supervision for Recovery Room and Condition Code 44 Services

  Providers should pay attention to two issues that were quietly discussed in the physician...

• Regulations: CMS publishes OPPS final rule

  On November 20, CMS published in the Federal Register the 2010 OPPS final rule. CMS had previously...

• Transmittals and MLN Matters articles: CMS issues updates to waived tests, NCCI edits, and more

  On November 20, CMS issued a transmittal to notify users of the intended rewrite of the integrated...

• Other Issuances: CMS issues RAC FAQ, OIG audits geographic classifications, and more

  On November 13, the OIG posted a report on oxaliplatin billing at Swedish Medical Center &ndash...

• CMS Public Events: No events this week

  There are no public events this week.

• MedicareFind Forum Spotlight: Consultation codes

  I have reviewed portions of the new Final Rule for 2010 that includes deletion of follow up...

Issue 47, November 17, 2009

• Note: More on deductibles and coinsurance

  CMS recently published the Part A deductible and coinsurance and Part B deductible amounts for CY...

• Regulations: No issuances this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals and MLN Matters articles: CMS issues RAC/ZPIC transmittal, issues MLN Matters articles, and more

  On November 16, CMS issued a transmittal to update the claims processing system to apply the new...

• Other Issuances: No releases this week

  Neither CMS nor the OIG released any other significant issuances this week affecting coverage...

• CMS Public Events: Hospital Open Door Forum

  The next Hospital & Hospital Quality Open Door Forum is scheduled for 2 p.m. Eastern, Thursday...

Issue 46, November 10, 2009

• Note: Signature for Laboratory Tests, Clarification in the MPFS Final Rule

  This week, I would like to review a “clarification” regarding physician signatures on...

• Regulations: CMS extends comment period for proposed ESRD PPS

  On November 4, CMS published a notice in the Federal Register to extend the comment period on its...

• Transmittals and MLN Matters articles: CMS updates lab NCD software, issues special edition article, and more

  On November 6th, CMS published an update to the Provider Reimbursement Manual (PRM) with Medicare...

• Other Issuances: Region D RAC posts updated audit issues, CMS issues H1N1 memo, and more

  On November 6, CMS issued a memo regarding recent developments to waive certain statutory and...

• CMS Public Events: IRF coverage criteria conference call

  CMS will hold a conference call at 2 p.m. (Eastern), Thursday, November 12, to discuss...

• MedicareFind tip: How to access the inpatient-only list

  CMS publishes the inpatient-only list with each OPPS final rule as Addendum E. The best way to...

Issue 45, November 3, 2009

• Sign up for our FREE MedicareFind webcast!

  Let us show you what MedicareFind can do and why it's the most efficient way to FIND what you need...

• Regulations: CMS displays OPPS, MPFS final rules for 2010, and more

  On October 30, CMS released a display copy of the OPPS final rule for CY 2010.

• Note: CMS issues 2010 final rule for ambulatory surgery centers and most hospital outpatient departments

  CMS has released a display copy of the outpatient prospective payment system (OPPS) final rule for...

• Transmittals and MLN Matters articles: CMS instructs on billing for voluntary ABNs, issues RAC transmittal, and more

  On October 30, CMS issued a transmittal to the Medicare Financial Management Manual pertaining to...

• Other Issuances: Region D RAC updates audit issues, OIG issues reports on oxaliplatin

  HealthDataInsights (HDI), the Region D RAC, has posted updates to its list of approved audit issues.

• CMS Public Events: No events this week

  There are no events this week.

Issue 44, October 27, 2009

• Note: CMS Announces the 2010 Medicare Premiums and Deductibles

  CMS recently announced the CY2010 Medicare Part A deductible for inpatient hospital services. When...

• Regulations: CMS announces inpatient hospital deductible and more

  On October 22, CMS published in the Federal Register three notices to announce the inpatient...

• Transmittals and MLN Matters articles: CMS updates interest rate, clotting factor fee, and more

  On October 23, CMS issued a transmittal to update the reasonable charge for splints, casts...

• Other Issuances: No releases this week

  Neither CMS nor the OIG released any other significant issuances this week affecting coverage...

• CMS Public Events: No events this week

  There are no public events this week.

Issue 43, October 20, 2009

• Note: Implementation of permanent and nationwide RAC Program

  Now that CMS has implemented a permanent and nationwide Recovery Audit Contractor (RAC) Program, as...

• Regulations: No issuances this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals and MLN Matters articles: No issuances this week

  CMS issued no significant transmittals or MLN Matters articles affecting hospital billing this week.

• Other Issuances: OIG audits Epogen, oxaliplatin, Region B RAC updates issues, and more

  CGI Federal, the RAC for Region B, has posted an updated list of approved audit issues.

• CMS Public Events: October 8 HODF transcript and audio available to MedicareFind subscribers

  Transcript and audio of the October 8 Hospital & Hospital Quality Open Door Forum (HODF) are...

Issue 42, October 13, 2009

• Note: Recent OIG Reports and Medical Review Implications

  In last week’s note, we looked at the OIG Work Plan for Fiscal Year 2010. There were many...

• Regulations: CMS issues IPPS correction, OCR publishes HIPAA proposal

  On October 7, CMS issued a correction in the Federal Register to its previously issued IPPS final...

• Transmittals and MLN Matters articles: CMS responds to OIG audits, releases special edition article on never events, and more

  On October 9, CMS issued a transmittal referencing several OIG reports that highlighted...

• Other Issuances: OIG reviews CERT, Region D RAC updates issues, and more

  On September 29, the OIG issued an audit report on the Comprehensive Error Rate Testing (CERT...

• CMS Public Events: No events this week

  There are no public events this week.

• FIND quarterly updates

  Flipping over the calendar from September to October means there are plenty of updates available to...

Issue 41, October 6, 2009

• Note: OIG releases Work Plan for Fiscal Year 2010

  The Office of Inspector General (OIG) of the Department of Health and Human Services has just...

• Regulations: OCR issues privacy rule proposal, CMS correct IRF PPS final rule

  On October 1, the Office for Civil Rights (OCR) issued a display copy of proposals to modify the...

• Transmittals and MLN Matters articles: CMS updates flu payment allowance, issues RAC mass adjustment transmittals

  On October 2, CMS issued a transmittal to update the payment allowances for the influenza vaccine...

• Other Issuances: OIG issues 2010 Work Plan, CMS updates lab NCDs, and more

  On October 1, the OIG issued its Work Plan for FY 2010.

• CMS Public Events: Hospital & Hospital Quality Open Door Forum

  The next Hospital & Hospital Quality Open Door Forum (HODF) is scheduled for Thursday, October...

Issue 40, September 29, 2009

• Condition Code 44 - The Next Chapter

  After CMS issued Transmittal 1803, we have continued to receive questions on the correct way to...

• Regulations: No issuances this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals and MLN Matters articles: CMS updates drug HCPCS hook and hold, rescinds/replaces transmittals, and more

  On September 25, CMS replaced its previous transmittal on LCD exceptions. It had previously sent...

• Other Issuances: CMS posts new RAC FAQ

  CMS released several new/updated FAQs, including the following: How long is the Recovery Audit...

• CMS Public Events: No events this week

  There are no public events this week.

• MedicareFind tip: Use spotlighting to FIND particular documents

  Sometimes you already know which particular transmittal, MLN Matters article, Job Aid article...

Issue 39, September 22, 2009

• Editor’s Note: Document links - You asked and we listened!

  In response to customer feedback, Medicare Weekly Update’s document links will now be open to...

• Note: CMS clarifies RACs' "exception authority"

  On September 11, CMS published Transmittal 302 that updated the Program Integrity Manual on Local...

• Regulations: No issuances this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals and MLN Matters articles: CMS rescinds/replaces transmittals, issues special edition MLN Matters

  On September 18, CMS rescinded and replaced two previous transmittals related to FDG PET coverage.

• Other Issuances: Region A RAC releases audit issues

  On September 21, DCS Healthcare Services, the Region A RAC contractor, released its list of...

• CMS Public Events: No events this week

  There are no public events this week.

Issue 38, September 15, 2009

• Note: Never Events - Updated guidance on reporting surgical errors for Medicare inpatients

  During the last few years, there has been considerable focus on certain events identified as...

• Regulations: No issuances this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals and MLN Matters articles: CMS updates IPPS, issues guidance on LCD exceptions, and more

  On September 9, CMS issued a transmittal updating the IPPS, LTCH PPS, and IPF PPS.  

• Other Issuances: Connolly updates approved issues, OIG audits oxaliplatin billing, and more

  On September 10, Connolly Healthcare, the Region C RAC contractor, updated its list of approved...

• CMS Public Events: No events this week

  There are no public events this week.

Issue 37, September 8, 2009

• Download your FREE on-demand MedicareFind webcast

  Please accept this invitation to obtain a FREE on-demand webcast of our recent MedicareFind...

• Note: CMS updates CLIA waived tests

  CMS recently issued Medicare Claims Processing Manual Transmittal 1799 (CR 6570), which is a...

• Regulations: No issuances this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals and MLN Matters articles: CMS releases MLN Matters articles

  CMS released several MLN Matters articles related to transmittals previously outlined in Medicare...

• Other Issuances: New ICD-9-CM guidelines available, RAC audit issues updated

  NCHS released new Official Guidelines for ICD-9-CM, effective October 1.

• CMS Public Events: Hospital Open Door Forum transcript, audio available

  The transcript and audio of the August 26 Hospital Open Door Forum (ODF) conference call are now...

Issue 36, September 1, 2009

• Note: Condition code 44 - The continuing saga

  On Friday, CMS issued Medicare Claims Processing Manual (MCPM) transmittal 1803, which is the...

• Regulations: IPPS final rule available in Federal Register

  On August 27, the inpatient prospective payment system (IPPS) final rule for FY 2010 was published...

• Transmittals and MLN Matters articles: CMS issues 5010 instructions, updates OPPS, I/OCE, and moreTransmittals and MLN Matters articles: CMS issues 5010 instructions, updates OPPS, I/OCE, and more

  On August 28, CMS issued transmittal R549OTN, in which it provided instructions to the MACs for...

• Other Issuances: Region B RAC posts approved issues, OIG issues audit reports, and more

  Last week, CGI Federal, the Region B RAC, made available a list of issues approved for RAC review...

• CMS Public Events: No events this week

  There are no public events this week.

Issue 35, August 25, 2009

• Note: Florida RAC Reviews See a New Issue Emerge

  Connolly Healthcare, the recovery audit contractor (RAC) for Region C, posted its CMS approved...

• Regulations: No issuances this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals and MLN Matters articles: CMS updates drug pricing files, issues MLN Matters articles, and more

  On August 21, CMS issued transmittal R1799CP to inform contractors of new waived tests approved by...

• Other Issuances: Connolly posts audit issues for Florida, OIG issues audit reports on Epogen payments

  Connolly Healthcare, the RAC for region C, has now posted issues for review in Florida.

• CMS Public Events: Hospital Open Door Forum

  The next Hospital & Hospital Quality Open Door Forum (HODF) is scheduled for Wednesday, August...

Issue 34, August 18, 2009

• Editor's Note: Source authority citations

  In response to reader feedback, Medicare Weekly Update will include appropriate textual citations...

• Note: Inpatient HINNs - Protecting the hospital’s right to recover payment for non-covered services

  Last week, I participated in an HCPro audioconference on HINNs. "HINN" stands for...

• Regulations: No issuances this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals and MLN Matters articles: No issuances this week

  CMS issued no significant transmittals or MLN Matters articles affecting hospital billing this week.

• Other Issuances: HDI posts approved issues, CMS issues memos, and more

  On August 12, HealthDataInsights (HDI) posted the approved audit issues for the RAC program in...

• CMS Public Events: No events this week

  There are no public events this week.

Issue 33, August 11, 2009

• Note: CMS announces a coverage determination on the "screening virtual colonoscopy"

  On August 7, CMS issued a transmittal (R105NCD) to implement its decision to maintain non-coverage...

• Regulations: IRF PPS published in Federal Register

  On August 7, the inpatient rehabilitation facility prospective payment system (IRF PPS) final rule...

• Transmittals and MLN Matters articles: CMS maintains noncoverage of CTC for colorectal cancer and more

  On August 7, CMS issued a transmittal to implement its decision to maintain noncoverage of computed...

• Other Issuances: No releases this week

  Neither CMS nor the OIG released any other significant issuances this week affecting coverage...

• CMS Public Events: No events this week

  There are no public events this week.

• MedicareFind tip: Bring relevant results NEARer

  Knowing that your keywords are close together in a document is important—the closer they are...

Issue 32, August 4, 2009

• Note: Inpatient Prospective Payment System (IPPS) Final Rule Announced

  On July 31, 2009, CMS issued the IPPS final rule announcing the changes that will affect the...

• Regulations: CMS issues 2010 final rule for IPPS, IRF PPS

  On July 31, CMS issued a display copy of the 2010 IPPS final rule.

• Transmittals and MLN Matters articles: CMS revises cost report, updates NCCI edits, and more

  On July 31, CMS released a transmittal providing guidance on the use of modifier -50 and add-on...

• Other Issuances: OIG issues audit report on high-dollar claims

  On July 16, the OIG released a report on high-dollar payments for outpatient claims processed by...

• CMS Public Events: No events this week

  There are no public events this week.

• MedicareFind Forum Spotlight: Physician supervision

  Go to the MedicareFind Forum and register for a FREE forum account to ask questions of your peers...

Issue 31, July 28, 2009

• Subscriber Alert from the Editor

  Until now, your Medicare Weekly Update e-newsletter has contained direct links to CMS source...

• Note: "Voluntary Refunds" to MACs/FIs

  Many providers are taking a proactive approach to the arrival of the Medicare Recovery Audit...

• Regulations: No issuances this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals and MLN Matters articles: CMS releases MLN Matters articles

  CMS released two MLN Matters article related to transmittals previously outlined in Medicare Weekly...

• Other Issuances: CMS posts NCD, OIG issues reports, ICD-9-CM errata available

  On July 21, CMS posted an NCD for sleep testing for OSA.

• CMS Public Events: Hospital Open Door Forum transcript, audio available

  The transcript and audio of the July 16 Hospital Open Door Forum (ODF) conference call are now...

• MedicareFind tip: Zero in on your manual with sub-filters

  CMS’ manual system is an important source of information and guidance — that’s...

Issue 30, July 21, 2009

• Note: Critical access hospitals and billing for non-patient laboratory testing

  In a May 12 post, clarification was given regarding a “non-patient” and reference...

• Regulations: OPPS proposed rule available in Federal Register

  On July 21, CMS published the 2010 OPPS proposed rule in the Federal Register. The proposed rule...

• Transmittals and MLN Matters articles: CMS implements NCD, releases MLN Matters article

  On July 17, CMS issued two transmittals to implement its recent NCD for FDG PET for solid tumors...

• Other Issuances: OIG issues audit reports on oxaliplatin, Epogen

  On July 1, the OIG issued two reports on oxaliplatin billing at Kootenai Medical Center and...

• CMS Public Events: No events this week

  There are no public events this week.

Issue 29, July 14, 2009

• Note: More on condition code 44 and observation

  We have received many questions on the articles we have published on the counting of hours of...

• Regulations: No issuances this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals and MLN Matters articles: CMS implements OSA NCD, prepares for lab NCD edit changes, and more

  On July 10, CMS issued a transmittal to update the interest rate for overpayments and underpayments...

• Other Issuances: CMS updates FAQs, OIG issues audit report

  On June 22, the OIG published a report on high-dollar payments for inpatient services made by...

• CMS Public Events: ODF conference call this week

  The next Hospital & Hospital Quality Open Door Forum (ODF) conference call is scheduled for...

• Sign up for our FREE MedicareFind webcast!

  Get the most out of MedicareFind by watching our demonstration of how to access primary authorities...

Issue 28, July 7, 2009

• Note: 2010 OPPS proposed rule released

  This was a busy week, but the biggest news was the somewhat early release of the OPPS proposed rule...

• Regulations: CMS issues OPPS proposed rule for CY 2010, and more

  On July 1, CMS issued a display copy of the OPPS proposed rule for CY 2010.

• Transmittals and MLN Matters articles: CMS re-issues never events transmittals, implements appeals changes

  On July 2, CMS replaced its previous transmittals on the recently issued NCDs for wrong surgery...

• Other Issuances: CMS posts NCDs for surgical never events, issues lab NCD update, and more

  On June 29, CMS posted on its Web site the three NCDs for surgical never events.  

• CMS Public Events: ODF rescheduled

  CMS has set the date of the next Hospital & Hospital Quality Open Door Forum (ODF) conference...

• MedicareFind tip: Know when to use quotation marks for your FIND!

  Performing a find for physician supervision (without quotation marks) means MedicareFind will look...

Issue 27, June 30, 2009

• Note: Inpatient Part B benefit - limited services payable under Part B to hospital inpatients

  Although there were several transmittals and other CMS issuances published during the past week...

• Regulations: No issuances this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals and MLN Matters articles: CMS re-issues OPPS update, released MLN Matters article for never events NCDs, and more

  On June 26, CMS instructed contractors to make system changes required for implementation of the...

• Other Issuances: CMS updates FAQs

  CMS issued several new/updated frequently asked questions (FAQ).

• CMS Public Events: No events this week

  There are no public events this week.

• MedicareFind tip: Narrow in as you go

  One frustrating aspect of searching for information on government web sites (e.g., CMS or the OIG...

• MedicareFind Forum: Ask your peers!

  Go to the MedicareFind Forum and register for a FREE forum account to ask questions of your peers...

Issue 26, June 23, 2009

• Note: More on condition code 44 and observation

  This is an especially light week of publications from CMS, so I thought I would update you a bit on...

• Regulations: No issuances this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals and MLN Matters articles: No issuances this week

  CMS issued no significant transmittals or MLN Matters articles affecting hospital billing this week.

• Other Issuances: CMS issues HITECH fact sheet, OIG audits oxaliplatin billing

  On June 16, CMS issued a fact sheet containing information and frequently asked questions about the...

• CMS Public Events: Open Door Forum rescheduled

  Although the next Hospital Open Door Forum was previously scheduled for June 25, Medicare Weekly...

• MedicareFind tip: Stay alert by bookmarking your FIND

  Staying current with Medicare-related rules and regulations is a challenge. The topics you need to...

Issue 25, June 16, 2009

• Note: Never Events - CMS issues surgical error NCDs and related guidance

  In 2002, the National Quality Forum (NQF) published a list of 27 events identified as...

• Regulations: No issuances this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals and MLN Matters articles: CMS implements NCDs for surgical never events, and more

  On June 12, CMS issued updates to the Claims Processing Manual and National Coverage Determinations...

• Other Issuances: ICD-9-CM documents available

  The fiscal year 2010 ICD-9-CM index to diseases addenda, tabular addenda, and new code conversion...

• CMS Public Events: No events this week

  There are no public events this week.

• MedicareFind tip: Customize your results with query expansion

  The MedicareFind engine is a powerful tool that enables you to access relevant source documents...

Issue 24, June 10, 2009

• Note: MedicareFind.com launches

  This week, you’ll notice a difference in the Medicare Weekly Update.  I’m pleased...

• Regulations: No issuances this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals and MLN Matters articles: CMS releases quarterly HCPCS update information, revised guidance on medical record entries, and more

  On June 5, CMS released a transmittal to implement the July 2009 update to HCPCS.

• Other Issuances: OIG issues report on NGS oxaliplatin claims, and more

  On June 5, CMS issued a memorandum in which it reiterated current policy that all surveys must be...

• CMS Public Events: No events this week

  There are no public events this week.

Issue 23, June 2, 2009

• Note: CMS replaces the term ’observation status’ with ’observation services’

  In the July 2009 quarterly updates, CMS revised portions of both the Claims Processing Manual and...

• Get customized regulatory updates!

  HCPro provides custom regulatory surveillance and analysis for all types of healthcare entities...

• Regulations: No issuances this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals and MLN Matters articles: CMS updates OPPS, NCCI, and more

  On May 29, CMS issued a transmittal to the State Operations Manual (SOM) in which it updated...

• Other Issuances: OIG issues report on oxaliplatin billing

  On May 18, the OIG issued an audit report on oxaliplatin billing at Providence Regional Medical...

• CMS Public Events: No events this week

  There are no public events this week.

Issue 22, May 26, 2009

• Note: New Modifiers for Outpatient Never Events; Billing for Hospital Acquired Conditions

  This week, CMS published the July Integrated Outpatient Code Editor (I/OCE).  Although there...

• Regulations: CMS published IPPS proposed rule in Federal Register

  On May 22, CMS published the IPPS proposed rule for fiscal year 2010 in the Federal Register. CMS...

• Transmittals and MLN Matters articles: CMS updates I/OCE, issues lab NCD software update, and more

  On May 15, CMS issued its regular quarterly average sales price Medicare Part B drug pricing files...

• Other Issuances: No releases this week

  Neither CMS nor the OIG released any other significant issuances this week affecting coverage...

• CMS Public Events

  There are no events this week.

Issue 21, May 19, 2009

• Note: Mass adjustment to post-acute transfer cases assigned to MS-DRG 956

  On May 8, 2009, CMS released transmittal R492OTN. This transmittal instructed Part A contractors...

• Regulations: No issuances this week

  CMS issued no significant regulations affecting hospital billing this week.

• MLN Matters articles: CMS clarifies new criteria for determining outpatient status for critical access hospitals, and more

  Last week, CMS released several MLN Matters articles related to transmittals previously outlined in...

• Other Issuances: OIG reviews oxaliplatin billing, CMS posts decision memo on CTCs

  On May 14, the OIG issued two reports on oxaliplatin billing. In both cases, the OIG determined...

• CMS Public Events

  There are no public events this week.

Issue 20, May 12, 2009

• Note: Clarification of reference (non-patient) laboratory testing

  CMS released Transmittal 1729 to the Claims Processing Manual this week, implementing provisions of...

• Regulations: 2010 IRF PPS proposed rule available in Federal Register

  On May 6, CMS published in the Federal Register the proposed rule for the fiscal year 2010...

• Transmittals and MLN Matters articles: CMS clarifies requirement for podiatric treatment, issues MLN Matters articles, and more

  On May 8, CMS issued instructions on the mass adjustment of claims for MS-DRG 956 (Limb...

• Other Issuances: OIG releases reports, CMS proposes decision memo, and more

  On May 8, the OIG issued a review of oxaliplatin billing at Providence Alaska Medical Center for...

• CMS Public Events

  There are no public events this week.

Issue 19, May 5, 2009

• Note: Proposed FY 2010 IPPS Rule - An overview

  On Friday May 1, CMS released the proposed inpatient prospective payment system (IPPS) rule for FY...

• IPPS final rule audio conference

  Don’t miss HCPro’s experts’ analysis of the IPPS final rule, which will be...

• Regulations: CMS issued 2010 IPPS proposed rule, and more

  On May 1, CMS released a display copy of the IPPS proposed rule for fiscal year 2010.

• Transmittals and MLN Matters articles: CMS announces instructions for new discharge status code, and more

  On May 1, CMS issued a transmittal updating system editing to ensure accurate billing, and...

• Other Issuances: OIG issues reports on oxaliplatin, E&M, and more

  On April 23, the OIG released a report on outpatient payments for oxaliplatin made in 2004 and 2005...

• CMS Public Events: Open Door Forum May 6

  The next Hospital & Hospital Quality Open Door Forum is scheduled for Wednesday, May 6, 2009...

Issue 18, April 28, 2009

• Note: Medically Unlikely Edits and medical necessity

  In last week’s Note from the Instructor, Kimberly Hoy focused on recently issued FAQ 9697. In...

• Regulations: No issuances this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals and MLN Matters articles: CMS implements diabetes surgery NCDs, revises Provider Reimbursement Manual

  CMS implements NCDs for surgery for diabetes   On April 17, CMS issued two transmittals...

• Other Issuances: OIG issues audit reports on oxaliplatin

  OIG issues review of oxaliplatin billing at Hilo Medical Center for CY 2004   On April 21...

• CMS Public Events

  There are no public events this week.

Issue 17, April 22, 2009

• Update: CMS Public Events - Open Door Forum rescheduled

  The next Hospital & Hospital Quality Open Door Forum has been rescheduled for Wednesday, May 6...

Issue 16, April 21, 2009

• Business associates: HIPAA survey

  We want to hear from business associates about their need for HIPAA training. Business associates...

• Note: Medically Unlikely Edits and ABNs

  This was an especially light week for items from CMS for hospitals. This is, perhaps, because...

• Regulations: No issuances this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals and MLN Matters articles: No issuances this week

  CMS issued no significant transmittals or MLN Matters articles affecting hospital billing this week.

• Other Issuances: CMS releases updated lab NCD manual, posts FAQ on MUEs, ABNs

  CMS has posted the April 2009 version of the NCD manual for clinical diagnostic laboratory services...

• CMS Public Events: Hospital Open Door Forum

  The next CMS Hospital & Hospital Quality Open Door Forum conference call is scheduled for April...

Issue 15, April 14, 2009

• Note: Compliance with Condition Code 44 - A practical approach

  This week, let’s continue our focus on the so-called Condition Code 44 process. If followed...

• Regulations: No issuances this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals: CMS lowers interest rate for overpayments and underpayments

  On April 9, CMS lowered the interest rate for Medicare overpayments and underpayments from 11.375...

• Other Issuances: OIG issues reviews of high-dollar claims, CMS updates FAQs

  On April 9, the OIG released a review of high-dollar payments for Medicare outpatient claims...

• CMS Public Events

  There are no public events this week.

Issue 14, April 7, 2009

• Note: Condition Code 44 - Let's focus on process

  This is the first of two additional Instructor’s Notes that will focus on Condition Code 44...

• Regulations: No issuances this week

  CMS issued no significant regulations affecting hospital billing this week.

• MLN Matters articles: SNF and therapy billing, ARRA provisions

  CMS released two MLN Matters articles related to transmittals previously outlined in Medicare...

• Other Issuances: CMS posts decision memo, updates FAQs

  On April 3, CMS posted a final decision memo in which it announced revisions to Section 220.6 of...

• CMS Public Events: ODF rescheduled to April 22

  The next CMS Hospital & Hospital Quality Open Door Forum conference call, previously scheduled...

Issue 13, March 31, 2009

• Note: Observation with condition code 44 and physician supervision

  Last week the American Health Lawyers Association held their annual Institute on Medicare and...

• Regulations: No issuances this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals: CMS implements ARRA provisions

  On March 27, CMS issued a transmittal to implement some provisions of the American Recovery and...

• Other Issuances: OIG issues report on quality roundtable

  On March 23, the OIG issued a report on the recent roundtable it cosponsored with the HCCA...

• CMS Public Events

  There are no public events this week.

Issue 12, March 24, 2009

• Note: CMS clarifies billing for devices and supplies

  This week, CMS published an MLN Matters article related to the April update to the OPPS published...

• Regulations: No issuances this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals: CMS revises SOM, issues MLN Matters articles

  On March 20, CMS issued a transmittal to change some portions of the State Operations Manual...

• Other Issuances: CMS issues memos, OIG issues reports, and more

  On March 20, the OIG issued a review of oxaliplatin billing at Baptist Hospitals of Southeast Texas...

• CMS Public Events

  There are no public events this week.

Issue 11, March 17, 2009

• Note: Hospital compliance with Medicare's post acute transfer rules

  Hospitals are ordinarily entitled to a full DRG payment when patients are discharged to their home...

• Regulations: No issuances this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals and MLN Matters articles: CMS issues CCI, I/OCE, OPPS updates, and more

  On March 13, CMS issued its quarterly CCI edits update for April.

• Other Issuances: OIG issues transfer policy review, CMS issues EMTALA memo

  On March 11, the OIG issued a report in which it determined that hospitals improperly coded 15,051...

• CMS Public Events

  There are no public events this week.

Issue 10, March 10, 2009

• Note: Hospitals must submit Medicare Advantage claims as far back as October 2005

  Last week, CMS published Transmittal 1695 to the Claims Processing Manual, reaching back to FY 2006...

• Regulations: No issuances this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals and MLN Matters articles: CMS updates MPFS, issues MLN Matters articles, and more

  On March 6, CMS issued a transmittal in which it instructed hospitals submit data on their FY 2006...

• Other Issuances: CMS issues final decision memo

  On March 3, CMS issued a final decision memo in which it establishes certain conditions of coverage...

• CMS Public Events

  There are no public events this week.

Issue 9, March 3, 2009

• Note: Application of critical care Correct Coding Initiative (CCI) edits to hospitals

  Effective January 1, 2009, the CCI edits for evaluation and management (E&M), including...

• Volunteers needed!

  HCPro is seeking a small group of volunteers to test a beta version of a new software application...

• Regulations: No issuances last week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals: CMS announces waived tests, releases MLN Matters articles

  On February 27, CMS released a transmittal announcing new waived tests approved by the FDA under...

• Other Issuances: CMS releases Heartsbreath NCD

  On February 23, CMS posted an NCD for the Heartsbreath test for heart transplant rejection in which...

• CMS Public Events

  There are no public events this week.

Issue 8, February 24, 2009

• Note: Locality adjustment for Medicare Physician Fee Schedule-based payments

  CMS issued Transmittal 1681 February 13, 2009, related to locality adjustment for payments made to...

• Regulations: No issuances this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals and MLN Matters articles: CMS releases April update to ASP drug pricing files, releases MLN Matters articles, and more

  On February 20, CMS issued its quarterly update to the ASP drug pricing files for Part B drugs not...

• Other Issuances: CMS updates FAQs, OIG releases audit reports, and more

  CMS released several updated frequently asked questions (FAQ) last week, related to Medicare...

• CMS Public Events: Hospital Open Door Forum

  The next CMS Hospital & Hospital Quality Open Door Forum conference call is scheduled for...

Issue 7, February 17, 2009

• Note: CMS increases its scrutiny of modifier -79 for multiple procedures

  Last week, CMS published a One Time Notification related to modifier -79 (Unrelated Procedure or...

• Regulations: No issuances this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals: CMS issues wage index corrections, changes lab NCD edit software, and more

  On February 13, CMS issued clarifying instructions on the calculation of payment amounts for...

• Other Issuances: CMS issues proposed, final decision memos, and more

  On February 13, CMS issued a memo in which it clarifies its enforcement approach to certain changes...

• CMS Public Events

  There are no public events this week.

Issue 6, February 10, 2009

• Important CY 2009 OPPS status indicator changes

  In CY 2008, CMS greatly expanded the number of packaged items and services payable under the...

• Regulations: No issuances last week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals and MLN Matters articles: CMS strengthens safeguard for facet joint injection services, issues transmittal on CAH co-surgeon payment, and more

  On February 6, CMS issued a transmittal instructing its contractors to strengthen safeguards...

• Other Issuances: RAC program moves forward, OIG releases audit reports

  On February 6, CMS announced that the permanent RAC program is once again underway as the RAC bid...

• CMS Public Events

  There are no public events this week.

Issue 5, February 3, 2009

• Watch for missing drug injection and infusion NCCI edits

  As many of you know, CMS maintains two sets of NCCI edits: one for hospitals and one for...

• Regulations: No issuances this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals: CMS Web site error

  Due to an error with the CMS Web site, transmittals issued last week were inaccessible before...

• Other Issuances: CMS releases NCD for PTA

  On January 26, CMS issued an NCD for PTA in which, consistent with its previously issued decision...

• CMS Public Events

  There are no public events this week.

Issue 4, January 27, 2009

• Prepare for approaching ABN deadline

  Medicare has been going through a number of transitions recently. One of these transitions relates...

• Regulations: CMS issues OPPS corrections

  On January 26, CMS published in the Federal Register technical corrections to the 2009 OPPS final...

• Transmittals: No issuances this week

  CMS released no significant transmittals or MLN Matters articles this week affecting coverage...

• Other Issuances: CMS updates FAQs, OIG releases review of payment for outpatient services

  CMS issues new/updated frequently asked questions; the OIG reviews high-dollar payments for...

• CMS Public Events

  There are no public events this week.

Issue 3, January 20, 2009

• Strategies for your ICD-10 implementation plan

  Last week, HHS announced October 1, 2013, as the final implementation date for ICD-10-CM/PCS...

• Regulations: ICD-10 final rule published, CMS proposes cytology PT changes

  HHS sets ICD-10-CM/PCS adoption for 2013, CMS proposes changes to cytology proficiency testing (PT...

• Transmittals: CMS clarifies policy on reopening claims, corrects previous OPPS update transmittal

  On January 16, CMS issued a transmittal clarifying what constitutes new and material evidence as...

• Other Issuances: CMS finalizes noncoverage of surgical never events

  On January 15, CMS issued national coverage determinations (NCD) finalizing its proposals not to...

• CMS Public Events

  CMS has no public events scheduled for this week.

Issue 2, January 13, 2009

• CMS releases OCE specifications

  Given that we are now into the second week of January, you have probably been wondering when CMS...

• Regulations: No issuances this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals and MLN Matters articles: CMS updates OCE specs, and more

  CMS updates OCE specifications, releases MLN Matters articles.

• Other Issuances: CMS selects final MACs, OIG issues report on high-dollar claims, and more

  On January 8, CMS issued the first results of its Hospital Outpatient Quality Data Reporting...

• CMS Public Events: ODF scheduled for January 15

  The next CMS Hospital & Hospital Quality Open Door Forum conference call is scheduled for...

Issue 1, January 6, 2009

• CMS updates manuals for OPPS 2009 payment policies

  While most everyone else was on vacation last week, CMS released two very significant transmittals...

• Regulations: CMS publishes corrections to 2009 IPPS final rule

  On December 30, CMS published in the Federal Register corrections to its original correction...

• Transmittals: CMS corrects previous lab fee schedule transmittal, updates OPPS, clarifies ESRD billing

  On December 31, CMS issued a transmittal rescinding and replacing a previous transmittal that...

• Other Issuances: None released this week

  Neither CMS nor the OIG released any other significant issuances this week affecting coverage...

• CMS Public Events

  CMS has no public events scheduled for this week.