Free Health Information Management e-Newsletters

APCs Weekly Monitor CDI Strategies Coding Educator HIM Connection HIPAA Weekly Advisor JustCoding News: Inpatient JustCoding News: Outpatient Medicare Weekly Update Recovery Auditor Report

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.

Subscribe »

2012 | 2011 | 2010 | 2009 | 2008 | 2007

Medicare Weekly Update

Issue 51, December 27, 2011

• Note: Looking Back at 2011

  I hope you had a wonderful holiday and are getting ready to start the New Year running! Let's...

• Regulations: None this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals and MLN Matters articles: CMS finalizes three-day window payment policy, corrects inconsistencies in the TOS update, and more

  CMS finalizes three-day window payment policy, corrects inconsistencies in the TOS update, and more

• Other issuances: CMS posts EHR incentive program FAQs

  CMS has posted a new set of FAQs on the electronic health record (EHR) incentive program

• CMS Public Events: None this week

  There are no public events this week.

• HCPro Watchdog Service

  Providers and payers alike have to stay on top of a regulatory environment that is constantly...

Issue 50, December 20, 2011

• Note: Medicare updates hospital inpatient and outpatient deductible and coinsurance amounts for 2012

  In a December 16 transmittal, CMS reported the CY 2012 rates for applicable Medicare Part A and...

• Regulations: CMS publishes CO-OP final rule and proposed rule requiring manufacturers report payments to providers

  On December 13, CMS issued a final rule in the Federal Register that implements the (CO-OP program...

• Transmittals and MLN Matters articles: CMS updates Medicare Deductible, Coinsurance and Premium Rates, and more

  CMS updates Medicare Deductible, Coinsurance and Premium Rates, and more

• Other issuances: CMS issues memo about certification of physician-owned hospitals

  On December 9, CMS issued a memo explaining that The Affordable Care Act prohibits the referral of...

• CMS Public Events: December 13 Physician Nurses & Allied Health ODF transcript available

  MedicareFind subscribers will be able to access the transcript and audio of the Physician Nurses...

• HCPro Watchdog Service

  Providers and payers alike have to stay on top of a regulatory environment that is constantly...

Issue 49, December 13, 2011

• Note: Physician supervision clarification still causing confusion

  In the 2012 OPPS Final Rule, CMS once again seems to have made unclear clarifications that are...

• Regulations: CMS issues final rule that will make performance measurement data more public

  On December 7, 2011, CMS published a final rule in the Federal Register that will make more...

• Transmittals and MLN Matters articles: CMS publishes new MLN Matters articles about preventive services

  CMS issued several MLN Matters articles based on transmittals that were covered in previous issues...

• Other issuances: OIG posts several reviews of hospitals' billing practices, CMS posts instructions for completing Hospital/CAH Database Worksheet

  This past week, the OIG posted four reviews of hospitals’ Medicare billing practices finding...

• CMS Public Events: Physician Nurses & Allied Health ODF December 13 and November 22 Hospital ODF transcript available

  The next Physician Nurses & Allied Health Open Door Forum (ODF) is scheduled for Tuesday...

Issue 48, December 6, 2011

• Note: CMS Continues to expand preventive benefits

  Last week CMS issued a press release that describes a new benefit that will cover intensive...

• Regulations: CMS publishes OPPS final rule and changes Advance Payment Model deadline

  As promised, CMS published the OPPS final rule in the Federal Register on November 30

• Transmittals and MLN Matters articles: CMS revises the Interpretive Guidelines and the HHABN

  CMS revises sections of the Interpretive Guidelines for hospitals and critical access hospitals...

• Other issuances: CMS posts press release about screening and counseling for obesity

  On November 29, CMS posted a press release announcing that Medicare will add screening and...

• CMS Public Events: None this week

  There are no public events this week.

• HCPro's 2011 Recovery Auditor Benchmarking Survey

  Be part of a comprehensive assessment of the recovery auditor program and learn how facilities...

Issue 47, November 29, 2011

• Note: CMS prepares to launch three new demonstration projects to strengthen Medicare by reducing fraud, waste and abuse

  Starting January 1, 2012, CMS will launch three demonstration projects designed to eliminate fraud...

• Regulations: CMS publishes the Medicare Physician Fee Schedule final rule

  CMS 12.00 Normal 0 false false false...

• Transmittals and MLN Matters articles: CMS will cover alcohol screening and counseling services for Medicare beneficiaries, and more

  On November 23, CMS published a transmittal that states Medicare will cover annual alcohol...

• Other issuances: None this week

  Neither CMS nor the OIG released any other issuances pertaining to hospital billing.

• CMS Public Events: None this week

  There are no public events this week.

Issue 46, November 22, 2011

• Note: The three-day payment window and new PD modifier

  Last week was rather quiet for CMS, so I wanted to bring forward guidance that CMS published in the...

• Regulations: None this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals and MLN Matters articles: CMS instructs payers to recoup incorrect ESRD PPS payments, and more

  On November 18, CMS issued a transmittal to notify Fiscal Intermediaries or Part A or Part B...

• Other Issuances: CMS unveils the Recovery Audit Program Prepayment Review demonstration, and more

  On November 15, CMS issued a fact sheet that describes the Recovery Audit Program Prepayment Review...

• CMS Public Events: Hospital Quality Open Door Forum November 22

  The next Hospital Quality Open Door Forum is scheduled for Tuesday, November 22, 2-3pm (Eastern).

Issue 45, November 15, 2011

• CMS summarizes key points of Hospital Inpatient Value-based Purchasing Program in 2012 OPPS Final Rule

  CMS included a brief summary of the key components of the Hospital Inpatient Value-based Purchasing...

• Regulations: CMS updates the 2012 ESRD PPS, revises DME definition, implements the DMEPOS Competitive Acquisition Program, and more

  CMS updates the 2012 ESRD PPS, revises DME definition, implements the DMEPOS Competitive...

• Transmittals and MLN Matters articles: CMS makes updates to DMEPOS Fee Schedule, ESRD PPS, FISS, and MCS

  CMS makes updates to DMEPOS Fee Schedule, ESRD PPS, FISS, and MCS

• Other Issuances: OIG report reveals lack of ZPIC oversight

  On November 10, the OIG published a report that states inaccuracies and lack of uniformity in ZPIC...

• CMS Public Events: None this week

  There are no public events this week.

Issue 44, November 8, 2011

• HCPro seeks participants for Development Partner Program

  The eSolutions team at HCPro is seeking volunteers to participate in its Development Partner Program

• Note: CMS posts OPPS final rule display copy, press release, and fact sheet

  Last week, HCPro sent out a breaking news story about the 2012 OPPS final rule, which applies to...

• Regulations: CMS publishes ACO final rule, Shared Savings Program waivers rule and 2012 premiums

  On November 2, CMS issued the accountable care organization (ACO) final rule.

• Transmittals and MLN Matters articles: CMS changes prostate cancer treatment policy, corrects past transmittals, and more

  CMS changes prostate cancer treatment policy, corrects past transmittals, and more

• Transmittals and MLN Matters articles: CMS changes prostate cancer treatment policy, corrects past transmittals, and more

  CMS changes prostate cancer treatment policy, corrects past transmittals, and more

• Other Issuances: OIG publishes a report on Medicare?s responses to adverse events in hospitals

  The OIG published a report which states that the agency found that Medicare missed opportunities to...

• CMS Public Events: None this week

  There are no public events this week.

Issue 43, November 1, 2011

• Note: NCCI update lags for hospitals

  It wasn’t an exciting week for releases from CMS. They must be preparing for the release of...

• Regulations: None this week

  CMS did not post any new regulations this week.

• Transmittals and MLN Matters articles: CMS published quarterly CCI edits, posts new waived tests, and more

  On October 28, CMS issued a transmittal to provide instructions for payment and CWF edits to be...

• CMS Public Events: None this week

  There are no public events this week.

• Other Issuances: None this week

  Neither CMS nor the OIG released any other issuances pertaining to hospital billing.

• Medicare Membership Program

  Get answers to your questions and Medicare compliance guidance from the experts all year...

Issue 42, October 25, 2011

• Note: Medicare conditions of participation up for revision

  CMS published a proposed rule regarding revisions to hospitals and critical access hospitals...

• Regulations: CMS proposes changes to ASC conditions of coverage and hospital participation requirements

  CMS issued a proposed rule that would revise the ASC conditions for coverage to allow patient...

• Transmittals and MLN Matters articles: CMS issues new interest rate for overpayments and underpayments

  CMS issued a transmittal that increases the interest rate for overpayment and underpayments twice.

• Other Issuances: CMS, DOJ, and FTC ACO information and CMS tests three new surveyor worksheets

  CMS, DOJ, and FTC ACO information and CMS tests three new surveyor worksheets

• CMS Public Events: None this week

  There are no public events this week.

Issue 41, October 18, 2011

• Note: Self-administered drugs Q&A

  Kimberly Hoy shares questions and answers about self-administered drugs.

• Regulations: CMS posts Medicare Advantage proposed rule

  On October 11, CMS published a proposed rule in the Federal Register to make changes to the...

• Transmittals and MLN Matters articles: No issuances this week

  CMS did not issue any transmittals or MLN Matters articles relevant to hospital billing or...

• Other Issuances: OIG reviews billing for outpatient drugs

  On October 6, the OIG issued a report of Medicare outpatient drug billing at Central Peninsula...

• CMS Public Events: None this week

  There are no public events this week.

• HCPro Watchdog Service

  Providers and payers alike have to stay on top of a regulatory environment that is constantly...

Issue 40, October 11, 2011

• Note: The OIG releases its FY 2012 Work Plan

  On October 5, the Department of Health and Human Services (HHS) released the Office of Inspector...

• Regulations: CMS extends deadline for Bundled Payments for Care Improvement initiative applications, OIG proposes to revise MFCU performance standards

  CMS extends deadline for Bundled Payments for Care Improvement initiative applications and the OIG...

• Transmittals and MLN Matters articles: CMS updates claim status codes and Medicare Claims Processing manual, and more

  CMS updates claim status codes and Medicare Claims Processing manual, and more

• Other Issuances: OIG releases 2012 Work Plan

  On October 5, the Department of Health and Human Services (HHS) released the Office of Inspector...

• CMS Public Events: None this week

  There are no public events this week.

Issue 39, October 4, 2011

• Note: Scrutiny on credits for devices increases

    This week Guidant LLC, a subsidiary of Boston Scientific, settled with the DOJ over...

• Transmittals and MLN Matters articles: CMS updates payment rate for swing-bed hospitals, revises manual, and corrects clerical errors

  CMS updates payment rate for swing-bed hospitals, revises manual, and corrects clerical errors

• Other Issuances: DOJ settles with Guidant, CMS extends mandatory use date for revised ABN, and more

  DOJ settles with Guidant, CMS extends mandatory use date for revised ABN, and more

• CMS Public Events: None this week

  There are no public events this week.

Issue 38, September 20, 2011

• Note: CMS establishes two new OPPS device categories for transitional pass-through status

  CMS provides updates on a quarterly basis during the calendar year to reflect changes to, and...

• Regulations: CMS updates appeals threshold, corrects IPPS, and more

  On September 23, CMS posted a notice in the Federal Register to announce the annual adjustment in...

• Note: CMS announces annual "amount in controversy" update for appeals

  In today’s environment of post payment audits, providers are well aware of their right to...

• Regulations: CMS posts Medicaid RAC final rule

  On September 14, CMS released a final rule on the Medicaid RACs. The rule sets the requirements...

• Transmittals and MLN Matters articles: CMS replaces transmittals

  CMS replaced several transmittals previously outlined in Medicare Weekly Update.

• Transmittals and MLN Matters articles: CMS updates "hook and hold" instructions, replaces transmittals, and more

  On September 23, CMS issued a transmittal to instruct contractors on the “hook and...

• Other Issuances: CMS announces new patient rights efforts, OIG audits outpatient claims

  The OIG released a review of Medicare payments exceeding charges for outpatient services processed...

• Other Issuances: OIG audits medical device claims

  The OIG has released a report on outpatient claims processed by Palmetto GBA that included...

• CMS Public Events: None this week

  There are no public events this week.

• CMS Public Events: None this week

  There are no public events this week.

Issue 37, September 13, 2011

• CMS Hospital Open Door Forum offers new guidance

  In today’s blog, I wanted to mention a couple items from the August 23 Open Door Forum.

• Regulations: None this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals and MLN Matters articles: CMS updates laboratory NCD, issues MLN Matters articles

  On September 2, CMS issued a transmittal to announce changes that will be included in the October...

• Other Issuances: None this week

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

• CMS Public Events: August 23 Hospital Open Door Forum transcript available

  MedicareFind subscribers can now access the transcript and audio of the Hospital & Hospital...

Issue 36, September 6, 2011

• Note: More about CMS' Bundled Payments Initiative launched recently by the newly created Innovation Center

  As discussed in last week’s Note, CMS recently announced an initiative to lower costs and...

• Regulations: None this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals and MLN Matters articles: CMS updates cost report, issues MLN Matters articles

  On August 30, CMS issued a transmittal to update Chapter 40 of the Provider Reimbursement Manual...

• Other Issuances: None this week

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

• CMS Public Events: None this week

  There are no public events this week.

Issue 35, August 30, 2011

• Note: CMS announces new initiative to lower costs and improve coordination of services during an episode of care

  On August 23, CMS announced a new initiative to lower costs and help doctors, hospitals and other...

• Regulations: None this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals and MLN Matters articles: CMS issues transmittal on MRI coverage, posts MLN Matters articles

  Effective for claims with dates of service on or after July 7, 2011, CMS believes that the...

• Other Issuances: None this week

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

• CMS Public Events: None this week

  There are no public events this week.

Issue 34, August 23, 2011

• Survey: Which CMS Open Door Forum calls are you interested in?

  We want to know which of the CMS Open Door Forum conference calls are of interest to you.

• Note: Bypassing medically unlikely edits (MUE)

  Last week was another light week at CMS so I wanted to go back to a previous transmittal that was...

• Regulations: None this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals and MLN Matters articles: CMS instructs on ICD-10, updates HCPCS, I/OCE, and more

  On August 19, CMS issued a transmittal to provide instructions and guidance on reporting, claims...

• Other Issuances: None this week

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

• CMS Public Events: Next Hospital Open Door Forum August 24

  The next Hospital and Hospital Quality Open Door Forum is scheduled for Wednesday, August 24, 2...

Issue 33, August 16, 2011

• Note: MS-DRG 265 added to IPPS replaced devices Policy

  Last week, we included a transmittal (R922OTN) and MLN Matters article (MM7457) for a DRG that was...

• Transmittals and MLN Matters articles: CMS posts MUE instructions

  On August 12, CMS issued a transmittal to give instructions regarding the medically unlikely edits...

• Regulations: None this week

  CMS issued no significant regulations affecting hospital billing this week.

• Other Issuances: CMS issues telemedicine survey letter

  CMS has issued a survey and certification letter regarding telemedicine services in hospitals and...

• CMS Public Events: None this week

  There are no public events this week.

Issue 32, August 9, 2011

• HCPro launches Development Partner Program

  The eSolutions team at HCPro has launched the Development Partner Program, which will integrate...

• Regulations: CMS posts IPPS final rule

  CMS has released a display copy of the IPPS final rule for fiscal year (FY) 2012. CMS will publish...

• Note: FY2012 IPPS final rule posted

  The FY2012 IPPS final rule was put on display this week.   The rule contained some...

• Transmittals/MLN Matters articles: CMS instructs on RAC demand letters, updates cardiac/pulmonary rehab edits, and more

  On July 29, CMS issued a transmittal to shift responsibility for issuance of demand letters from...

• CMS Public Events: None this week

  There are no public events this week.

• Other Issuances: None this week

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

Issue 31, August 2, 2011

• Note: New and confusing guidance on self-administered drugs

  Coverage of self administered drugs under Part B is very confusing, but I thought I at least had...

• Regulations: None this week

  CMS issued no significant regulations affecting hospital billing this week.

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

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

• Other Issuances: None this week

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

• CMS Public Events: None this week

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

Issue 30, July 26, 2011

• Note: CMS releases revised ABN, mandatory on and after November 1, 2011

  During the July 13 Hospital Open Door Forum call, CMS announced the release of a revised ABN form...

• Regulations: CMS publishes OPPS proposals

  On July 18, CMS published in the Federal Register a proposed rule to modify the OPPS for calendar...

• Transmittals and MLN Matters articles: CMS updates CLIA list, lab NCD edits

  On July 22, CMS issued a transmittal to inform contractors of new HCPCS codes subject to the CLIA...

• Other Issuances: None this week

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

• CMS Public Events: July 13 Hospital Open Door Forum transcript available

  MedicareFind subscribers can now access the transcript and audio of the Hospital & Hospital...

Issue 29, July 19, 2011

• Note: OPPS proposed rule affects imaging payments

  In 2011, the AMA introduced three new CPT codes for computed tomography (CT) of the abdomen and...

• Regulations: No issuances this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals and MLN Matters articles: CMS issues NCD for prostate cancer treatment, updates ESRD PPS, and more

  On July 15, CMS issued a transmittal to make quarterly updates to the end-stage renal disease...

• Other Issuances: None this week

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

• CMS Public Events: None this week

  There are no public events this week.  

Issue 28, July 12, 2011

• Note: CMS announces 2012 OPPS proposed rule

  CMS released the OPPS proposed rule almost one month earlier than we usually see it.  CMS...

• Regulations: CMS proposes OPPS, MPFS changes

  CMS has released a display copy of a proposed rule to make changes to the OPPS for 2012.

• Transmittals and MLN Matters articles: CMS posts MLN Matters article

  CMS issued an MLN Matters article related to a transmittal previously outlined in Medicare Weekly...

• Other Issuances: CMS updates lab NCDs, OPPS addenda

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

• CMS Public Events: Hospital Open Door Forum July 13

  The next Hospital Open Door Forum is scheduled for Wednesday, July 13, 2 – 3 pm (Eastern...

Issue 27, July 5, 2011

• Regulations: CMS proposes to rescind lab signature requirement

  On June 30, CMS issued a proposed rule that would rescind the requirement it adopted in its recent...

• Note: ABNs revisited

  CMS recently announced that it has issued a revised informational booklet on ABNs entitled...

• Transmittals and MLN Matters articles: None this week

  CMS did not issue any transmittals or MLN Matters articles relevant to hospital billing or...

• Other Issuances: CMS posts new manual, OCE specifications

  CMS has posted the quarterly update specifications for the outpatient code editor (OCE).

• CMS Public Events: None this week

  There are no public events this week.

Issue 26, June 28, 2011

• Note: Special editions highlight inpatient coding vulnerabilities and admit date issues

  CMS released two special edition MLN articles this week.  One article, SE1121, highlights some...

• Regulations: None this week

  CMS issued no significant regulations affecting hospital billing this week.  

• Transmittals and MLN Matters articles: CMS advises on documentation, notifies of new waived tests, and more

  CMS has issued a special MLN Matters article on DRG coding vulnerabilities for inpatient...

• Other Issuances: None this week

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

• CMS Public Events: None this week

  There are no public events this week.

Issue 25, June 21, 2011

• MedicareFind users: We'll help FIND what you need

  MedicareFind subscribers and free trial users -- do you need help finding transmittals, rulemaking...

• Note: Provider-friendly change to tracking observation hours

  In the July OPPS update, CMS made a manual change to the section on counting observation hours that...

• Regulations: CMS corrects IPPS proposed rule

  On June 14, CMS issued a notice in the Federal Register to make technical corrections to its...

• Transmittals and MLN Matters articles: None this week

  CMS did not release any transmittals or MLN Matters articles this week affecting coverage, billing...

• Other Issuances: CMS posts new IPPE FAQs

  CMS has posted a new set of FAQs on the initial preventive physical examination (IPPE).

• CMS Public Events: None this week

  There are no public events this week.

Issue 24, June 14, 2011

• Note: Medicaid payments and provider-preventable conditions

  Last February, I wrote about the proposed rule for Medicaid health care-acquired conditions (HCACs...

• Regulations: CMS corrects IPF PPS, publishes Medicaid HCAC final rule

  On June 3, CMS published in the Federal Register a correction to its previously issued rate year...

• Transmittals and MLN Matters articles: CMS clarifies on CAH optional method, CMS updates SNF consolidated billing

  On June 3, CMS issued a transmittal to make updates to skilled nursing facility (SNF) consolidated...

• Other Issuances: None this week

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

• CMS Public Events: June 1 Hospital Open Door Forum transcript available

  MedicareFind subscribers can now access the transcript and audio of the Hospital & Hospital...

Issue 23, June 7, 2011

• Note: The new frontier of coverage denials

  This week CMS released a special edition MLN Matters article reviewing the coverage of...

• Regulations: HHS issues HIPAA/HITECH regulations, CMS finalizes Medicaid HCAC rule

  On June 1, CMS released a rule to finalize a payment adjustment for provider-preventable...

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

  CMS has issued its regular updates to the OPPS for July. The update includes information on new...

• Other Issuances: HHS posts regulatory review plan

  HHS has posted its plan for retrospective review of existing regulations.

• CMS Public Events: None this week

  There are no public events this week.

Issue 22, May 31, 2011

• Note: Accountable care organizations - A new way to coordinate the delivery of quality healthcare to beneficiaries enrolled in original Medicare

  In an effort to provide quality healthcare to beneficiaries enrolled in original Medicare (Medicare...

• Regulations: No issuances this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals and MLN Matters articles: CMS clarifies CRNA pass-through, updates IPF PPS, and more

  On May 20, CMS issued a transmittal to provide further clarification regarding certified...

• Other Issuances: None this week

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

• CMS Public Events: Hospital Open Door Forum June 1

  The next Hospital & Hospital Quality Open Door Forum is scheduled for Wednesday, June 1, from...

Issue 21, May 24, 2011

• Note: Critical access hospitals and ambulance services

  This was another light week at CMS, so I wanted to return to the FY 2012 IPPS proposed rule to talk...

• Regulations: No issuances this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals and MLN Matters articles: CMS issues MLN Matters article

  CMS released an MLN Matters article related to a transmittal previously outlined in Medicare Weekly...

• Other Issuances: CMS advises on SNF consolidated billing, claims processing issues, and more

  On May 16, the OIG issued a report on CMS’ oversight and enforcement of HIPAA. The OIG...

• CMS Public Events: None this week

  There are no public events this week.

Issue 20, May 17, 2011

• Note: Payers misunderstand HACs and never events

  This week was a light week so I thought I would write about a trend I’ve come across related...

• Regulations: No issuances this week

  CMS issued no significant regulations affecting hospital billing this week.

• Other Issuances: None this week

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

• Transmittals and MLN Matters articles: CMS clarifies pharmacy billing, posts NCCI update instructions, and more

  On May 13, CMS issued a transmittal to clarify policy with respect to restrictions on pharmacy...

• CMS Public Events: None this week

  There are no public events this week.

• MedicareFind Forum Spotlight: Brachytherapy

  High dose brachytherapy is not listed as an inpatient procedure but requires a patient to remain...

Issue 19, May 10, 2011

• Note: CMS announces a "three-day payment window clarification" in the IPPS proposed rule

  Last week, I addressed one of the clarifications that CMS had announced in the FY 2012 IPPS...

• Regulations: CMS finalizes value-based purchasing program, opens IPPS proposed rule for comments, and more

  On May 5, CMS published in the Federal Register a final rule revise the conditions of...

• Transmittals and MLN Matters articles: CMS updates cost report, implements K codes, and more

  On April 29, CMS issued a transmittal to make further revisions to CMS-2552-96, the Hospital and...

• Other Issuances: None this week

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

• CMS Public Events: April 27 Hospital Open Door Forum transcript available

  MedicareFind subscribers can now access the transcript and audio of the Hospital & Hospital...

Issue 18, May 3, 2011

• Note: CMS announces a "clarification" in the IPPS proposed rule

  Last week, my colleague Kimberly Hoy wrote about the IPPS proposed rule for FY 2012 and listed...

• Regulations: CMS finalizes value-based purchasing provisions, issues IRF PPS proposed rule, and more

  CMS has posted a display copy of a final rule to implement a value-based purchasing program under...

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

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

• Other Issuances: CMS posts RAC summary

  CMS has posted a summary document to outline the top audit issues for each RAC and provide...

• CMS Public Events: None this week

  There are no public events this week.

Issue 17, April 26, 2011

• Note: CMS publishes IPPS proposed rule for 2012

  Last week, CMS put on display the proposed rule for IPPS services and other inpatient initiatives...

• Regulations: CMS posts IPPS proposed rule for 2012

  CMS has issued for public inspection a proposed rule to make changes to the inpatient prospective...

• Transmittals and MLN Matters articles: CMS makes manual revisions for inpatient billing, posts new waived tests

  On April 22, CMS issued a transmittal to make minor updates to the Claims Processing Manual...

• Other Issuances: None this week

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

• CMS Public Events: Hospital Open Door Forum April 27

  The next Hospital and Hospital Quality Open Door Forum conference call will be held 2 – 3 pm...

Issue 16, April 19, 2011

• Note: Attestation for the Medicare EHR incentive program began April 18

  The attestation period for those providers—eligible professionals (EPs), eligible hospitals...

• Regulations: HHS seeks input on regulatory review

  On April 13, HHS published in the Federal Register a request for information regarding its...

• Transmittals and MLN Matters articles: CMS updates interest rates for overpayments/underpayments

  On April 12, CMS issued a transmittal to update the interest rate for overpayments and...

• Other Issuances: None this week

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

• CMS Public Events: Hospital Open Door Forum April 27

  The next Hospital and Hospital Quality Open Door Forum conference call is being held 2 – 3...

• MedicareFind spotlight: Free MedicareFind demonstration May 4

  Sign up for our free May 4 demonstration of MedicareFind to learn more about this comprehensive...

Issue 15, April 12, 2011

• Note: Preventive services are preventing payment

  Beginning January 1, 2011, under the Patient Protection and Affordable Care Act (ACA), CMS waived...

• Regulations: Comment on the ACO/waiver rulemaking

  CMS and the OIG have published rulemaking on accountable care organizations (ACO) and applicable...

• Transmittals and MLN Matters articles: None this week

  CMS released no transmittals or MLN Matters articles related to hospital reimbursement.

• Other Issuances: CMS posts new NCCI files, releases HAC data, and issues preventive services guidance

  CMS has released the quarterly update to the NCCI edits, up to v. 17.0 for hospital outpatient...

• CMS Public Events: None this week

  There are no public events this week.

• MedicareFind spotlight: Medicaid selections added to MedicareFind

  MedicareFind subscribers have access to a new content archive in MedicareFind – added...

Issue 14, April 5, 2011

• Note: Implementation of the critical care composite APC

  My colleague, Judith Kares, wrote about the new CPT guidance on critical care for 2011 and the...

• Regulations: HHS releases ACO rulemaking

  CMS and the OIG have released display copies of a proposed rule and notice regarding accountable...

• Transmittals and MLN Matters articles: CMS replaces transmittals, posts MLN Matters articles

  CMS rescinded and replaced two transmittals previously outlined in Medicare Weekly Update.

• Other Issuances: CMS posts quarterly OPPS, CLFS, MUE updates

  CMS has posted new Addendum A and Addendum B files under the OPPS for April.

• CMS Public Events: None this week

  There are no public events this week.

Issue 13, March 29, 2011

• Note: Destination. . . Medicare education

  During the Medicare Boot Camps, the instructors demonstrate places to go to sign up for free...

• Regulations: CMS posts 2011 Medicare enrollment application fee

  On March 23, CMS published in the Federal Register a notice to announce the $505 calendar year...

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

  On March 25, CMS issued a transmittal to update the list of HCPCS codes subject to the skilled...

• Other Issuances: CMS updates lab edit module

  CMS has released the most recent version of its lab NCD manual.

• CMS Public Events: None this week

  There are no public events this week.

• MedicareMentor Blog spotlight: Signature requirement for lab requisitions

  Those of us who have wondered what the outcome will be of CMS’ three-month delay in...

Issue 12, March 22, 2011

• Note: CMS emphasizes importance of reporting diagnostic radiopharmaceuticals along with the related nuclear medicine procedures

  In its April quarterly update to the Outpatient Prospective Payment System (OPPS), CMS continued to...

• Regulations: OIG proposes to allow MFCU data mining

  On March 17, the OIG published in the Federal Register a proposed rule that would allow the use of...

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

  On March 18, CMS issued a transmittal to make quarterly updates to the OPPS for April. The...

• Other Issuances: CMS updates I/OCE, GAO testifies on improper payments

  On March 9, Government Accountability Office (GAO) staff testified before a Congressional...

• CMS Public Events: None this week

  There are no public events this week.

• MedicareFind spotlight: Free MedicareFind demonstration April 6

  Sign up for our free April 6 demonstration of MedicareFind to learn more about this comprehensive...

Issue 11, March 15, 2011

• Note: Medicare issues a reminder on the importance of billing the correct place of service on physician claims

  In a recent MLN Matters article, Medicare once again reminded physicians and their billing agents...

• Regulations: CMS issues OPPS corrections

  On March 11, CMS published in the Federal Register corrections to the 2011 OPPS final rule.

• Transmittals and MLN Matters articles: CMS updates outpatient code editor, instructs on place-of-service coding

  CMS has released a special edition MLN Matters article on place-of-service coding in response to...

• Other Issuances: No releases this week

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

• CMS Public Events: None this week

  There are no public events this week.

• MedicareMentor Blog spotlight: Observation patients

  After having discussions with the Medicare Specialist and Nurse Auditor at my facility, I was...

Issue 10, March 8, 2011

• Note: Reporting time for drug administration services

  This week I thought I’d take the opportunity to address a confusing coding issue related to...

• Regulations: No issuances this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals and MLN Matters articles: CMS issues MRI NCD, revises cost report, and more

  On March 4, CMS issued two transmittals to set coverage parameters for magnetic resonance imaging...

• Other Issuances: No releases this week

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

• CMS Public Events: February 23 Hospital Open Door Forum transcript available

  MedicareFind subscribers can now access the transcript and audio of the Hospital & Hospital...

• MedicareFind Forum Spotlight: CAHs

  I'm looking for information regarding Critical Access Hospitals. If the hospital had a rate change...

Issue 9, March 1, 2011

• Regulations: No issuances this week

  CMS issued no significant regulations affecting hospital billing this week.

• Note: Medicare clarifies benefit for annual wellness visit, including personalized prevention plan services

  In two recent transmittals (and a related MLN Matters article) Medicare clarified its new benefit...

• Transmittals and MLN Matters articles: CMS instructs on use of claims history, updates underpayment guidance, and more

  On February 25, CMS issued a transmittal to instruct its auditing contractors (e.g., RAC, CERT...

• Other Issuances: CMS delays Medicaid RACs, issues provider compliance newsletter

  CMS posted a letter to delay the timeline for implementation of the Medicaid RACs. States will not...

• CMS Public Events: None this week

  There are no public events this week.

Issue 8, February 22, 2011

• Note: More alphabet soup. . . HCACs, PPCs, and OPPCs

  Add a dash of HCAC, a pinch of PPC, and a dollop of OPPC and you get the proposed rule on Medicaid...

• Regulations: CMS proposes Medicaid payment reductions for provider-preventable events

  On February 16, CMS posted a proposed rule that would reduce payment to Medicaid providers for...

• Transmittals and MLN Matters articles: CMS re-issues AWV transmittals

  On February 16, CMS issued a transmittal to clarify and incorporate manual language regarding the...

• Other Issuances: CMS unveils esMD electronic record submission system

  CMS posted information this week on a new electronic option for submitting medical records in...

• CMS Public Events: Hospital Open Door Forum February 23

  The next Hospital & Hospital Quality Open Door Forum is scheduled for Wednesday, February 23...

• MedicareFind Forum Spotlight: CLIA waived tests

  How should we bill Medicare for clia waived tests in a provider based clinic?  Should it be...

Issue 7, February 15, 2011

• Note: Determining inpatient medical necessity for procedures

  CMS was very quiet during the past week. That tends to make me a little nervous – you know...

• Regulations: No issuances this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals and MLN Matters articles: CMS replaces transmittal, posts MLN articles

  CMS rescinded and replaced a transmittal previously outlined in Medicare Weekly Update.

• Other Issuances: No releases this week

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

• CMS Public Events: None this week

  There are no public events this week.

Issue 6, February 8, 2011

• Note: CMS orders all contractors to automatically deny claim line items submitted with a -GZ modifier

  In two recently issued transmittals, CMS ordered all contractors – MACs, CERTs, RACs, PSCs...

• Regulations: CMS publishes screening requirements final rule

  CMS published in the Federal Register a final rule to implement provisions of the Patient...

• Transmittals and MLN Matters articles: CMS directs on -GZ denials, complex review

  On February 4, CMS issued two transmittals to require contractors to automatically deny claim...

• Other Issuances: No releases this week

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

• CMS Public Events: None this week

  There are no public events this week.

• MedicareFind spotlight: Free MedicareFind demonstration March 2

  Sign up for our free March 2 demonstration of MedicareFind to learn more about this comprehensive...

Issue 5, February 1, 2011

• Note: Inpatient-only procedures and the three-day rule

  CMS has clarified that outpatient procedures that meet preadmission packaging requirements and...

• Regulations: CMS posts IPF PPS proposed rule, screening requirements final rule

  CMS has issued a display copy of a final rule to implement provisions of the Patient Protection...

• Transmittals and MLN Matters articles: CMS posts special article on admission screening criteria, implements lab payment demonstration, and more

  CMS has posted a special edition MLN Matters article on inpatient admission decisions and the use...

• Other Issuances: CMS issues anesthesia guidance, CLIA memo

  On January 14, CMS issued a memorandum to state survey directors to further clarify requirements...

• CMS Public Events: None this week

  There are no public events this week.

Issue 4, January 25, 2011

• Note: CMS clarifies payment for CRNA Services in a CAH and transmittal dates

  Critical access hospitals (CAHs) are hospitals that have met very specific requirements &ndash...

• Regulations: No issuances this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals and MLN Matters articles: CMS makes timely filing changes, modifies IPPS Pricer, and more

  On January 21, CMS issued a transmittal to update its manual system with changes to the timely...

• Other Issuances: CMS posts new RAC FAQ on 60-day requirement

  What happens if the recovery auditor does not meet the 60 day requirement?

• CMS Public Events: January 13 Hospital Open Door Forum transcript available

  MedicareFind subscribers can now access the transcript and audio of the Hospital & Hospital...

• MedicareMentor Blog Spotlight: Annual wellness visit

  What diagnosis code should be used with the G0438 procedure code?

Issue 3, January 18, 2011

• Note:CMS issues proposed rule on value-based incentive payments to acute care hospitals under the IPPS

  As part of its continuing efforts to forge a closer link between Medicare’s payment systems...

• Regulations: CMS removes advance care planning from annual wellness visit, publishes value-based purchasing proposal

  On January 13, CMS published in the Federal Register a proposed rule that would establish a...

• 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: No releases this week

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

• CMS Public Events: None this week

  There are no public events this week.

Issue 2, January 11, 2011

• Note: Implementation of the CY 2011 OPPS final rule begins

  As you are aware, the most significant changes to the Medicare rules that apply to outpatient...

• Regulations: CMS proposes value-based purchasing, finalizes permanent HIT certification rule, and more

  On January 7, CMS issued a display copy of a proposed rule that would establish a hospital...

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

  On December 30, CMS issued two transmittals to implement updates to the OPPS for 2011. Changes...

• Other Issuances: CMS posts updated MUEs

  CMS has released new medically unlikely edit (MUE) files for the first quarter of 2011.

• CMS Public Events: Hospital Open Door Forum Janaury 12

  The next Hospital and Hospital Quality Open Door Forum is scheduled for Wednesday, January 12...

Issue 1, January 4, 2011

• Note: The year in review

  I hope you had a wonderful holiday and started the new year in style!  Things were pretty...

• Regulations: CMS publishes EMTALA notice, seeks RAC comments, and more

  On December 28, the OIG published in the Federal Register its annual notice to solicit proposals...

• Transmittals and MLN Matters articles: CMS posts new cost report, issues emergency MPFS update, and more

  On December 30, CMS issued a transmittal to implement a new hospital cost report (CMS-2552-10...

• Other Issuances: CMS issues lab NCD manual

  CMS has issued the lab NCD manual for the first quarter of 2011.

• CMS Public Events: None this week

  There are no public events this week.