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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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Issue 49, December 4, 2012

• Notice: Your subscription will have a new name in the coming weeks!

  Very shortly, Medicare Weekly Update will be replaced with Medicare Insider.

• Notice: Your subscription will have a new name in the coming weeks!

  Very shortly, Medicare Weekly Update will be replaced with Medicare Insider.

• CMS releases the details for the outpatient therapy claims-based data collection requirement

  Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the...

• Regulations: CMS issues draft notice of Benefit and Payment Parameters for 2014

  CMS issues draft notice of Benefit and Payment Parameters for 2014

• Transmittals and MLN Matters articles: CMS issues therapy cap values for CY 2013, instructs on claims-based data colelction for outpatient therapy services, and more

  CMS issues therapy cap values for CY 2013

• Other issuances: CMS issues press release on prescription drug cost savings, fact sheet on building exchanges, and more

  CMS issues press release on prescription drug cost savings

• CMS Public Events: Transcript and audio for October 22 Manual Medical Review of Therapy Claims Special ODF

  The transcript and audio file for the October 22, 2012 Manual Medical Review of Therapy Claims...

Issue 48, November 27, 2012

• Regulations: CMS issues three proposed rules related to the Affordable Care Act

  CMS issues three proposed rules related to the Affordable Care Act

• Transmittals and MLN Matters articles: None this week

  CMS issued no transmittals or MLN Matters articles this week.

• Other issuances: OIG issues a number of reviews and CMS issues fact sheet and press releases

  CMS issues notice on hospital outpatient payment panel

• CMS Public Events: Hospital and physician value-based payment modifier open door forums

  The next Hospital & Hospital Quality Open Door Forum is scheduled for today, Tuesday, November...

Issue 47, November 20, 2012

• Note from the instructor: OIG weighs in on ALJ appeals

  Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the...

• Regulations: CMS posts two final rules in Federal Register

  CMS issues 2013 OPPS final rule in Federal Register

• Transmittals and MLN Matters articles: CMS issues transmittal on testing HIPAA transactions following a system change, updates chapter 41 of the Provider Reimbursement Manual, and more

  CMS issues transmittal on testing HIPAA transactions following a system change

• Other issuances: OIG issues reviews of Medicare appeals at the Administrative Law Judge level in 2010 and payments to skilled nursing facilities in 2009

  Other issuances: OIG issues reviews of Medicare appeals at the administrative law judge level in...

Issue 46, November 13, 2012

• Recovery Auditors on the hot seat: Scrutiny pouring in from numerous angles

  Recovery Auditors on the hot seat: Scrutiny pouring in from numerous angles

• Regulations: None this week

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• Transmittals and MLN Matters articles: CMS issues transmittal on the ESRD PPS, revised CMS-1500 form, and more

  CMS replaces transmittal on MPPR on the TC of diagnostic cardiovascular and ophthalmology...

• Other issuances: OIG issues reviews of outpatient billing for selected drugs in Calif. And more

  CMS issues technology assessment on electronic cardiac devices

• CMS Public Events: Physicians, Nurses & Allied Health Professionals Open Door Forum

  CMS held a Physicians, Nurses & Allied Health Professionals Open Door Forum on Friday, November...

Issue 45, November 6, 2012

• Note from the instructor: CMS publishes the 2013 OPPS and MPFS final rules

  Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the...

• Regulations: CMS issued the following final rule: 2013 OPPS, Physician Fee Schedule, Home Health PPS, and End Stage Renal Disease PPS

  CMS issues 2013 OPPS final rule

• Transmittals and MLN Matters articles: CMS issues Medicare system update to include rendering line level NPI for PCIP payments to CAHs and much more

  CMS issues Medicare system update to include rendering line level NPI for PCIP payments to CAHs

• Other issuances: CMS issues letters on a nursing home clarification and the ESRD core survey process, and more

  CMS issues nursing home clarification letter

• CMS Public Events: None this week

  CMS Public Events: None this week

Issue 44, October 30, 2012

• Note from the instructor: Clarification regarding $716 billion in cost savings to Medicare Program under the Affordable Care Act

  Editor’s note: Judith Kares, JD, CPC, regulatory specialist for HCPro, Inc., is the author of...

• Regulations: CMS issues corrections to two final rules

  CMS issues corrections to 2013 IPPS final rule

• Other issuances: OIG issues Medicare compliance review, CMS issues press release and fact sheet, and more

  OIG issues Medicare compliance review of Missouri hospital

Issue 43, October 23, 2012

• New! Revenue Cycle Institute releases 2012 Principal Diagnosis White Paper

  The Revenue Cycle Institute has released a new white paper

• Regulations: CMS issues correcting amendment to 2013 IPPS final rule

  CMS issues correcting amendment to 2013 IPPS final rule

• Transmittals and MLN Matters articles: CMS updates two manuals and more

  CMS updates chapter 7, Medicare Financial Management Manual

• Other issuances: CMS issues press release on 2013 quality ratings for Medicare health and drug plans and more

  CMS issues details on evidentiary characteristics for CED MEDCAC meeting

• CMS Public Events: Two upcoming special open door forums

  CMS will hold a Special Open Door Forum on the Prior Authorization of Power Mobility Devices...

Issue 42, October 16, 2012

• Note from the instructor: Correction to the FY2013 IPPS Final Rule

  Editor’s note: Kimberly Hoy, Esq., director of Medicare and compliance for HCPro, Inc., is...

• Transmittals and MLN Matters articles: CMS issues notice of new interest rate for Medicare overpayments and underpayments and more

  CMS issues notice of new interest rate for Medicare overpayments and underpayments

• Other issuances: CMS issues press release on 2013 quality ratings for Medicare health and drug plans and more

  CMS issues press release on 2013 quality ratings for Medicare health and drug plans

• CMS Public Events: Two upcoming special open door forums

  CMS will hold a Special Open Door Forum on ACA Section 3004: Quality Reporting Program for...

Issue 41, October 9, 2012

• Note from the instructor: Hospital Outpatient Payment Panel announces recommendations

  Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the...

• Other issuances: CMS and NCHS issue 2013 ICD-10-CM official guidelines and more

  CMS and NCHS issue 2013 ICD-10-CM official guidelines

• Regulations: CMS issues corrections to two final rules

  CMS issues corrections to administrative simplification final rule

• Transmittals and MLN Matters articles: CMS issues new waived tests, annual clotting factor furnishing fee update 2013, and more

  CMS issues new waived tests

• CMS Public Events: National Provider Call on Provider Enrollment

  CMS will hold a National Provider Call on Medicare Provider Enrollment on Wednesday, October 10...

Issue 40, October 2, 2012

• Note from the instructor: Implementation of FY 2013 Value-Based Purchasing Program (VBPP) and Hospital Readmission Reduction Program (HRRP) adjustments to IPPS hospital operating payments has begun

  Editor’s note: Judith Kares, JD, CPC, regulatory specialist for HCPro, Inc., is the author of...

• Transmittals and MLN Matters articles: CMS replaces transmittal on manual medical review of therapy services and more

  CMS replaces transmittal on manual medical review of therapy services

• Other issuances: CMS issues preliminary decisions on recommendations of outpatient payment panel on supervision levels for select services and more

  Other issuances: CMS issues preliminary decisions on recommendations of outpatient payment panel on...

• CMS Public Events: National Provider Call on Provider Enrollment

  CMS will hold a National Provider Call on Medicare Provider Enrollment on Wednesday, October 10...

Issue 39, September 25, 2012

• Note from the instructor: CMS policies and conversion from ICD-9 to ICD-10

  Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the...

• Transmittals and MLN Matters articles: CMS issues transmittal on ICD-10 conversions from ICD-9 and more

  CMS issues transmittal on ICD-10 conversions from ICD-9  

• Other issuances: CMS issues press release on Medicare Advantage and Affordable Care Act

  CMS issues press release on Medicare Advantage

• CMS Public Events: Two open door forums this week

  CMS will hold a Special Open Door Forum on Medicare's Prior Authorization for Power Mobility...

Issue 38, September 18, 2012

• Note from the instructor: National provider call on implementation of Value-based Purchasing Program to be held in October

  Editor’s note: Judith Kares, JD, CPC, regulatory specialist for HCPro, Inc., is the author of...

• Transmittals and MLN Matters articles: CMS issues training series for nursing homes and more

  CMS issues training series for nursing homes  

• Other issuances: OIG issues review of inpatient rehabilitation facility claims with late patient assessment instruments and more

  OIG issues review of inpatient rehabilitation facility claims with late patient assessment...

• HCPro Watchdog Service

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

Issue 37, September 11, 2012

• Note from the instructor: Outpatient therapy manual medical reviews begin October 1 for hospitals

  Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the...

• Regulations: CMS issues administrative simplification final rule and EHR incentive program final rule

  CMS issues administrative simplification final rule

• Transmittals and MLN Matters articles: CMS issues transmittal on expiration of 2012 therapy cap revisions and user-controlled mechanism to identify legislative effective dates and more

  CMS issues transmittal on expiration of 2012 therapy cap revisions and user-controlled mechanism to...

• Other issuances: CMS issues revised manual instructions for the ABN and more

  CMS issues technology assessment on ECG-based analysis technologies

• CMS Public Events: Affordable Care Act Implementation Update

  CMS will hold a conference call on an Affordable Care Act Implementation Update for Clinicians...

Issue 36, September 4, 2012

• Note from the instructor: CMS Releases October OPPS Update

  CMS released the October OPPS update this week with a smattering of unrelated, but important...

• Regulations: CMS issues final rule for revisions to Medicare IPPS

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

  On August 24, CMS issued a transmittal describing changes to and billing instructions for various...

• Other issuances: CMS announces Stage 2 for EHR Incentive Programs and more

  HHS adopts a HIPAA standard for a unique health plan identifier

Issue 35, August 28, 2012

• Note from the instructor: HHS announces next steps in the promotion and implementation of electronic health records (EHR) by hospitals and health care professionals

  On August 23, DHHS announced the requirements for Stage 2 in the movement toward implementation of...

• Transmittals and MLN Matters articles: None this week

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• Other issuances: CMS announces Stage 2 for EHR Incentive Programs and more

  CMS announces Stage 2 final rule for Medicare and Medicaid EHR Incentive Programs  On August...

• CMS Public Events: None this week

  There are no CMS public events this week. 

Issue 34, August 21, 2012

• Note from the instructor: Corrections to OPPS payment rates and OPPS and IPPS wage indices

  Editor’s note: Judith Kares, JD, CPC, regulatory specialist for HCPro, Inc., is the author of...

• Regulations: None this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals and MLN Matters articles: CMS updates IPF PPS and IRF PPS pricer changes for FY 2013

  CMS updates inpatient psychiatric facilities PPS for FY 2013

• Other issuances: OIG issues report on leuprolide acetate injections in Ohio and more

  OIG issues report on leuprolide acetate injections in Ohio

• CMS Public Events: Recovery Auditor prepayment review ODF transcript and audio

  The transcript & audio file from the August 9, 2012 Medicare Fee-For-Service Recovery Auditor...

Issue 33, August 14, 2012

• Note from the instructor: Financial impacts of the Hospital Readmissions Reduction Program

  Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the...

• Regulations: CMS issues interim final rule for healthcare EFT and RA transactions

  CMS issues interim final rule for adoption of operating rules for healthcare EFT and RA transactions

• Transmittals and MLN Matters articles: CMS issues new non-physician specialty code for centralized flu and much more

  CMS issues October 2012 quarterly ASP Part B drug pricing files and revisions to prior files

• Other issuances: CMS issues NCDs and OIG issues inappropriate billing reports

  CMS issues NCD for TAVR (20.32)

• CMS Public Events: Preventative services open door forum

  CMS will hold a National Provider Call on the new Medicare covered preventive services on August...

Issue 32, August 7, 2012

• Note from the instructor: CMS issues FY2013 IPPS Final Rule

  Editor's Note: Kimberly Hoy, Esq., director of Medicare and compliance for HCPro, Inc., is the...

• Regulations: CMS releases 2013 IPPS final rule

  On August 1, CMS issued a display copy of the 2013 inpatient prospective payment system final rule.

• Transmittals and MLN Matters articles: CMS issues directions to modify institutional reason code 39012

  CMS issues directions to modify institutional reason code 39012

• Other issuances: OIG issues Medicare compliance review of Boston hospital and more

  CMS issues an NCA for autologous blood-derived products for chronic non-healing wounds (CAG-00190R3)

• CMS Public Events: Special Recovery Auditor prepayment review demonstration open door forum

  CMS will hold a special open door forum on the Medicare fee-for-service Recovery Auditor prepayment...

Issue 31, July 31, 2012

• Note from the instructor: CMS posts questions and answers on three-day window

  Editor's Note: Kimberly Hoy, Esq., director of Medicare and compliance for HCPro, Inc., is the...

• Regulations: CMS issues two proposed rules in the Federal Register

  CMS issues 2013 OPPS proposed rule  

• Transmittals and MLN Matters articles: CMS issues new waived tests

  CMS issues new waived tests

• Other issuances: Obama administration announces public-private partnership to prevent healthcare fraud and CMS issues an NCA

  Obama administration announces public-private partnership to prevent healthcare fraud

• CMS Public Events: Hospital and Hospital Quality, and Physician Nurses and Allied Health Open Door Forum transcript and audio

  Starting tomorrow, the transcript and audio files for the Physicians, Nurses and Allied Health...

Issue 30, July 23, 2012

• Note from the instructor: Impact of sequestration on the Medicare and Medicaid Programs

  A year ago, Congress and the Administration were locked in bitterly contended, and ultimately...

• Regulations: CMS posts final rule to establish Patient Protection and Affordable Care Act data collection standards

  Normal 0 false false false EN-US X-NONE X-NONE...

• Transmittals and MLN Matters articles: None this week

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• Other issuances: CMS announces state healthcare innovation initiative and more

  Other issuances: CMS announces state healthcare innovation initiative and more

• CMS Public Events: Transcript and audio files for Physicians and Hospital Open Door Forums

  MedicareFind subscribers will be able to access the transcript and audio files of the Physicians...

Issue 29, July 16, 2012

• Note from the instructor: Impact of proposed geometric mean cost data for APC relative weight calculations

  Last week we announced that the CY 2013 OPPS Proposed Rule had been published by CMS in a display...

• Regulations: CMS issues two proposed rules in the Federal Register

  Regulations: CMS issues two proposed rules in the Federal Register

• Transmittals and MLN Matters articles: CMS replaces transmittal on coverage of extracorporeal photopheresis, issues transmittal on new interest rate for Medicare overpayments and underpayments

  Transmittals and MLN Matters articles: CMS replaces transmittal on coverage of extracorporeal...

• Other issuances: CMS names 89 new Medicare shared savings accountable care organizations and more

  CMS names 89 new Medicare shared savings accountable care organizations and more

• CMS Public Events: Hospital and Hospital Quality, and Physician Nurses and Allied Health Open Door Forums

  The next Physician Nurses and Allied Health Open Door Forum is scheduled for Tuesday July 17 from 2...

Issue 28, July 10, 2012

• Note from the instructor: CMS announces CY 2013 OPPS proposed rule

  Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the...

• Regulations: CMS issues 2013 OPPS proposed rule, 2013 physician fee schedule proposed rule, and more

  CMS issues 2013 OPPS proposed rule

• Transmittals and MLN Matters articles: CMS replaces transmittal on reporting of recoupment for overpayment on the RA

  CMS replaces transmittal on reporting of recoupment for overpayment on the RA

• Other issuances: CMS issues three-day payment window FAQs, 2012 Nursing Home Action Plan, and more

  CMS issues three-day payment window FAQs

• CMS Public Events: None this week

  There are no public events this week.

Issue 27, July 3, 2012

• Note from the instructor: Revised Mental Health Services Booklet (ICN 903195) available through Medicare Learning Network

  Editor’s note: Judith Kares, JD, CPC, regulatory specialist for HCPro, Inc., is the author of...

• Regulations: None this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals and MLN Matters articles: CMS updates Medicare Managed Care Manual and more

  CMS replaces transmittal on October quarterly update HCPCS codes used for SNF CB enforcement  

• Other issuances: CMS issues press release on healthcare law and more

  CMS issues press release on healthcare law

• CMS Public Events: None this week

  There are no public events this week.

Issue 26, June 26, 2012

• Note from the instructor: Changes to device edits for July 2012

  Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the...

• Transmittals and MLN Matters articles: CMS instructs on provider self audits

  CMS issues transmittal on provider self audits

• Other issuances: OIG issues Medicare compliance reviews and more

  CMS issues an NCA for liver transplantation for malignancies

• CMS Public Events: Prior Authorization for Power Mobility Devices Demonstration ODF scheduled for June 28

  CMS will hold a special Open Door Forum on Thursday, June 28, 2012 to provide an opportunity for...

• Regulations: None this week

  Regulations: None this week

Issue 25, June 19, 2012

• Note from the instructor: July OPPS update: Self-administered drugs

  Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the...

• Regulations: CMS issues Medicare secondary payer and future medicals proposed rule and more

  CMS posts IPPS proposed and final rules, relevant correction notices for FY 2013

• Transmittals and MLN Matters articles: CMS issues transmittal on process for handling esMD and more

  CMS issues transmittal on process for handling esMD

• Other issuances: CMS issues July 2012 NCD Coding Policy Manual and Change Report and more

  CMS issues July 2012 NCD Coding Policy Manual and Change Report

• CMS Public Events: June 5 Physicians, Nurses and Allied Health Professionals Open Door Forum transcript and audio

  Starting tomorrow, MedicareFind subscribers will be able to access the transcript and audio of the...

Issue 24, June 12, 2012

• Note from the instructor: July 2012 quarterly update contains multiple significant updates and clarifications

  Editor's Note: Kimberly Hoy, Esq., director of Medicare and compliance for HCPro, Inc., is the...

• Regulations: CMS issues corrections to 2013 IPPS proposed rule

  CMS issues corrections to 2013 IPPS proposed rule

• Transmittals and MLN Matters articles: CMS issues July 2012 OPPS update, manual changes regarding ABN forms, and more

  CMS issues July 2012 OPPS update

• Other issuances: OIG issues report on payment for nonphysician outpatient services and more

  OIG issues report on payment for nonphysician outpatient services

• CMS Public Events: June 5 Physicians, Nurses and Allied Health Professionals Open Door Forum transcript and audio

  The transcript and audio of the Physician Nurses & Allied Health Open Door Forum (ODF...

Issue 23, June 5, 2012

• Note from the instructor: CMS announces supervision levels for select services

  Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the...

• Regulations: CMS issues corrections to two final rules

  CMS issues correction to Medicare Advantage and prescription drug benefit final rule

• Transmittals and MLN Matters articles: CMS issues clarification of Medicare conditional payment policy and billing procedures for liability, no-fault, and workers' compensation MSP claims and more

  CMS issues clarification of Medicare conditional payment policy and billing procedures for...

• Other issuances: OIG issues review of jurisdiction 13 IRF claims that did not comply with transfer regulations and more

  OIG issues review of jurisdiction 13 IRF claims that did not comply with transfer regulations

• CMS Public Events: EHR incentive program and Physican Nurses and Allied Health Open Door Forums

  On Thursday, June 7, 2012 CMS will hold a National Provider Call for eligible professionals (EPs...

Issue 22, May 29, 2012

• Note from the instructor: CMS to release new short-term acute care PEPPER

  Editor’s note: Judith Kares, JD, CPC, regulatory specialist for HCPro, Inc., is the author of...

• Regulations: None this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals and MLN Matters articles: CMS replaces transmittal on screening for STIs and HIBC to prevent STIs (ICD-10) and more

  CMS replaces transmittal on screening for STIs and HIBC to prevent STIs (ICD-10)

• Other issuances: CMS instructs on use of insulin pens in healthcare facilities and more.

  CMS instructs on use of insulin pens in healthcare facilities

• CMS Public Events: None this week

  There are no public events this week.

Issue 21, May 22, 2012

• Note from the instructor: CMS issuing National Coverage Determinations (NCDs) with ICD-10 translations

  Editor's Note: Kimberly Hoy, Esq., director of Medicare and compliance for HCPro, Inc., is the...

• Regulations: CMS posts rules to cut regulations for hospitals and providers

  CMS posts rules to cut regulations for hospitals and providers

• Transmittals and MLN Matters articles: CMS updates the enrollment manual and more

  CMS issues general update to chapter 15 of the PIM – Part VI

• Other issuances: National coverage analysis for TENS for low back pain

  CMS issues an NCA for transcutaneous electrical nerve stimulation for chronic low back pain...

• CMS Public Events: May 16 Hospital & Hospital Quality ODF transcript available

  Starting tomorrow, MedicareFind subscribers will be able to access the transcript and audio of the...

Issue 20, May 15, 2012

• Note from the instructor: New CoP addresses patient self-administration of medications

  Editor's Note: Kimberly Hoy, Esq., director of Medicare and compliance for HCPro, Inc., is the...

• Regulations: CMS releases 2013 IPPS proposed rule, finalizes rules to cut regulations for hospitals and providers, saving more than $5 billion

  CMS releases 2013 IPPS proposed rule, finalizes rules to cut regulations for hospitals and...

• Transmittals and MLN Matters articles: CMS instructs on implementation of fraud prevention predictive modeling prepayment edits and more

  CMS instructs on implementation of fraud prevention predictive modeling prepayment edits and more

• Other issuances: OIG issues Medicare compliance reviews and CMS issues an NCA for autologous blood-derived products for chronic non-healing wounds

  OIG issues compliance re view of Missouri hospital

• CMS Public Events: Hospital ODF scheduled for May 16

  The next Hospital, Hospital Quality Open Door Forum is scheduled for Wednesday, May 16, 2012 from 2...

Issue 19, May 8, 2012

• Note from the Instructor: CMS issues further guidance on outpatient therapy caps and the related exceptions process

  In a recent transmittal, CMS issued guidance on Congress’ extension of limitations on certain...

• Regulations: CMS issues Medicaid community first choice option final rule and Medicaid state plan home and community-based services proposed rule

  On May 7, CMS issued in the Federal Register a final rule that implements section 2401 of the...

• Transmittals and MLN Matters articles: CMS issues transmittal containing revisions of the financial limitation for outpatient therapy services and more

  On April 27, CMS issued a transmittal that extends the therapy cap exceptions process through...

• Other issuances: OIG issues review of outpatient brachytherapy payments in Florida and more

  On May 3, the OIG issued a review of outpatient brachytherapy Medicare payments at Lakewood Rance...

• CMS Public Events: April 25 Hospital ODF transcript available and more

  The transcript of the Hospital, Hospital Quality Open Door Forum conference call held April 25 is...

Issue 18, May 1, 2012

• Note from the Instructor: CMS releases the IPPS Proposed Rule

  Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the...

• Regulations: CMS issues IPPS proposed rule, issues 2012 OPPS corrections, and more

  CMS issues IPPS proposed rule for FY2013

• Transmittals and MLN Matters articles: CMS issues guidance on overpayment recovery from DMEPOS suppliers and updates part 1, chapter 9 of the Provider Reimbursement Manual

  CMS issues guidance on overpayment recovery from DMEPOS suppliers

• Other issuances: OIG issues billing compliance reports, CMS issues guidance on determination rural location, and more

  OIG issues report on Southern Calif. Renal Disease Council inc. billing compliance

• CMS Public Events: None this week

  There are no public events this week.

Issue 17, April 24, 2012

• Note from the Instructor: ICD-10 Delay

  Editor's Note: Kimberly Hoy, Esq., director of Medicare and compliance for HCPro, Inc., is the...

• Regulations: HHS issues administrative simplification proposed rule, CMS issues corrections to EHR proposed rule

  HHS issues administrative simplification proposed rule

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

  MLN Matters articles

• Other issuances: OIG posts new compliance reviews, CMS issues press release on home health agency patient surveys, and more

  OIG issues Medicare compliance review of D.C. hospital

• CMS Public Events: April 17 Hospital & Hospital Quality ODF transcript available

  Starting tomorrow, MedicareFind subscribers will be able to access the transcript and audio of the...

• Free HCCA Lunch and Learn - Reserve your space now and qualify to win an Apple iPad 3

  Join HCPro and guest speaker Kimberly Hoy, Director of Medicare and Compliance for HCPro and...

Issue 16, April 17, 2012

• Note: CMS provides additional guidance on proper billing when the Medicare Secondary Payer Rules apply

  In a recent Special Edition MLN Matters Article (SE1217), CMS reminded providers of their...

• Regulations: CMS makes changes to the Medicare Advantage and prescription drug benefit

  On April 12, CMS issued a final rule that revises the Medicare Advantage program regulations and...

• Transmittals and MLN Matters articles: CMS updates Program Integrity Manual, CLIA waived test list, and more

  CMS issued two transmittals this past week that continue its process of updating chapter 15 of the...

• Other issuances: CMS instructs FIs/MACs to hold claims containing CPT code 33249 and HCPCS code C1882

  The July, 2012 I/OCE (V13.2) will be updated with a new procedure-to-device edit file that will...

• CMS Public Events: Physician Nurses & Allied Health ODF scheduled for April 17

  The next Physicians, Nurses & Allied Health Professionals Open Door Forum conference call is...

Issue 15, April 10, 2012

• Note: CMS clarifies regulations for outpatient rehabilitation and respiratory services

  I will take this time to review a transmittal that came out several weeks ago about a topic that I...

• Regulations: CMS proposes one-year delay of ICD-10-CM/PCS

  On April 9, CMS released a proposed rule announcing a one-year delay of the implementation of...

• Transmittals and MLN Matters articles: CMS revises "incident to" transmittal

  On April 4, CMS rescinded Transmittal 2368 dated December 15, 2011, and replaced it with...

• Other issuances: OIG issues review of Medicare outpatient billing for selected drugs at Catskill Regional Medical Center

  The OIG reviewed Medicare payments made to Catskill Regional Medical Center, located in Harris, NY...

• CMS Public Events: None this week

  There are no public events this week.

Issue 14, April 3, 2012

• Note: NCCI edits more user-friendly despite some modifier confusion

  CMS has recently made a number of improvements to the usefulness of the NCCI edits including a new...

• Regulations: HHS issues Affordable Insurance Exchanges final rule

  On March 27, HHS issued a final rule in the Federal Register that implements the new Affordable...

• Transmittals and MLN Matters articles: CMS revises screening and counseling transmittals, updates DMEPOS HCPCS code jurisdiction, and more

  Last week, CMS rescinded and replaced three transmittals related to screening and behavioral...

• Other issuances: CMS updates additional documentation limits for Recovery Auditors, NCDs

  On March 12, CMS issued an update that effectively raises the additional documentation requests...

• CMS Public Events: Hospital ODF scheduled for April 4

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

Issue 13, March 27, 2012

• Note: Special provisions in MCTRJCA affecting hospitals

  The Middle Class Tax Relief and Job Creation Act of 2012 (MCTRJCA) contained a number of provisions...

• Regulations: HHS proposes amendments to preventive services regulations, CMS accepts applications for a new demonstration project, and more

  On March 21, the U.S. Department of Health and Human Services (HHS) published a proposed rule in...

• Transmittals and MLN Matters articles: CMS publishes ASC update, issues transmittal to explain MCTRJCA changes, and more

  On March 16, CMS issued a transmittal that describes changes made to the April 2012 ambulatory...

• Other issuances: CMS publishes 5010 FAQs and OIG identifies $1.5 million in overpayments made to Boston hospital

  CMS has posted several new FAQs about the transition to HIPAA 5010.

• CMS Public Events: None this week

  There are no public events this week.

Issue 12, March 20, 2012

• Note: New procedure, drugs and edits in the April quarterly hospital outpatient guidance

  CMS released the April quarterly OPPS and I/OCE updates, and there are several items of interest...

• Regulations: CMS revises DMEPOS supplier safeguards

  On March 14, CMs published a final rule in the Federal Register that removes the definition of...

• Transmittals and MLN Matters articles: CMS updates I/OCE specifications, corrects implementation dates for VMS shared system

  On March 9, CMS issued a transmittal that updates the specifications for the integrated outpatient...

• Other issuances: CMS redesigns claims and benefits statement, posts IPPS pricer file, and more

  As part of National Consumer Protection Week, the CMS Acting Administrator, Marilyn Tavenner...

• 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 11, March 13, 2012

• CMS issues additional guidance on patient rights to privacy, including medical record confidentiality

  CMS recently issued further guidance on patient rights to privacy and medical record...

• Regulations: CMS publishes EHR proposed rule, HHS publishes HIT standards

  CMS publishes EHR proposed rule, HHS publishes HIT standards

• Transmittals and MLN Matters articles: CMS replaces intensive behavioral therapy for obesity transmittal

  CMS replaces intensive behavioral therapy for obesity transmittal

• Other issuances: OIG publishes review of cardiac medical device credits, CMS publishes patient privacy guidance

  OIG publishes review of cardiac medical device credits, CMS publishes patient privacy guidance

• CMS Public Events: Transcript available for March 6 Physician Nurses & Allied Health ODF

  The transcript and audio of the Physician Nurses & Allied Health Open Door Forum (ODF...

Issue 10, March 6, 2012

• Note: CMS requires the creation of improper payment edits

  Last week, CMS released two related transmittals that rescinded prior transmittals. These rescinded...

• Regulations: None this week

  CMS issued no significant regulations affecting hospital billing this week.

• Transmittals and MLN Matters articles: CMS makes quarterly OPPS update and replaces several transmittals

  CMS makes quarterly OPPS update and replaces several transmittals

• Other issuances: New Hampshire first to get new healthcare law funds and OIG posts audit report

  New Hampshire first to get new healthcare law funds and OIG posts audit report

• CMS Public Events: Physician Nurses & Allied Health ODF scheduled for March 6

  The next Physicians, Nurses & Allied Health Professionals Open Door Forum conference call is...

• HCPro Watchdog Service

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

Issue 9, February 28, 2012

• Note: CMS sends notice to providers about overlapping dates of service

  On February 24, CMS sent a notice to providers about claims inappropriately overlapping when billed...

• Regulations: CMS issues EHR incentive program Stage 2 proposed rule, increases the maximum contingency fee paid to recovery auditors, and more

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• Transmittals and MLN Matters articles: CMS updates healthcare provider taxonomy codes and releases new Special Edition MLN Matters articles

  On February 17, CMS posted the April 2012 update to the healthcare provider taxonomy code lists.

• Other issuances: CMS issues important information for provider regarding the billing of hospital outpatient and inpatient ancillary services

  On February 24, CMS sent a notice to providers about claims inappropriately overlapping when billed...

• CMS Public Events: Transcript available for February 22 Hospital & Hospital Quality ODF

  The transcript and audio of the Hospital & Hospital Quality Open Door Forum (ODF) conference...

• HCPro Watchdog Service

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

Issue 8, February 21, 2012

• Note: Reporting and returning overpayments

  Providers and suppliers should take note of the new requirements CMS has proposed with regard to...

• Regulations: CMS proposes to amend deadline for repayment of overpayments

  On February 16, CMS published a proposed rule in the Federal Register that would require providers...

• Transmittals and MLN Matters articles: CMS updates standard file for reason codes and adds exhibits to immediate recoupment of overpayments transmittal

  On February 10, CMS published a transmittal that announces the quarterly update to the CMS standard...

• Other issuances: HHS announces intent to delay ICD-10 compliance date, OIG posts compliance reviews

  HHS announces intent to delay ICD-10 compliance date

• CMS Public Events: Hospital ODF scheduled for February 22

  Hospital & Hospital Quality Open Door Forum scheduled for February 22

Issue 7, February 14, 2012

• Note: CMS posts revised fact sheet on swing bed services

  As part of its Rural Health Fact Sheet Series, CMS recently issued a revised fact sheet on swing...

• Regulations: None this week

  CMS issued no significant regulations affecting hospital billing this week.

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

  CMS has posted an MLN Matters article related to a transmittal previously outlined in Medicare...

• Other issuances: OIG posts new compliance reviews, CMS posts new FAQs

  Springhill Medical Center, located in Mobile, AL, complied with Medicare billing requirements for...

• CMS Public Events: National provider call for the Hospital Value-based Purchasing Program

  On Tuesday, February 28, 2012, CMS will host a National Provider call for hospitals from 1:30...

• HCPro Watchdog Service

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

Issue 6, February 7, 2012

• Note: Recovery audits result in changes to CMS systems and recoupment options

  This week CMS published two transmittals that affect CMS systems as a result of the recovery audit...

• Regulations: CMS corrects IPPS final rule errors, publishes outpatient drug proposed rule, and requests comments regarding transfers

  On February 1, CMS corrected technical errors that occurred in Tables 2, 4C, and 9A of the fiscal...

• Transmittals and MLN Matters articles: CMS revises POS code assignment policy, posts new waived tests, and more

  On February 3, CMS issued a transmittal that revises and clarifies its national policy for place of...

• Other issuances: OIG posts a same-day readmission review and CMS posts new FAQs

  On January 30, the OIG posted a report that states St. Mary's Hospital, located in Richmond...

• 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 5, January 31, 2012

• Note: Timely filing and adjustment of hospital claims

  During a recent Medicare Boot Camp – Hospital Version class, a participants raised several...

• Regulations: CMS modifies the hospital OPPS 2012 payment rates

  On January 23, CMS modified the “Final Changes to the Hospital OPPS and CY 2012 Payment...

• Transmittals and MLN Matters articles: CMS covers STI screenings, creates new claims edits, updates PIM, and more

  On January 26, CMS issued a pair of transmittals that state it will cover screening for Chlamydia...

• Other issuances: None this week

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

• CMS Public Events: Transcript available for January 24 Physician Nurses & Allied Health ODF

  The transcript and audio of the Physician Nurses & Allied Health Open Door Forum (ODF...

Issue 4, January 24, 2012

• Note: Corrections to January Quarterly OPPS Update; January OCE Review

  This week CMS rescinded and replaced the January (outpatient prospective payment system) OPPS...

• Regulations: Proposed rule would extend DSH payments to cover the cost of each service furnished to an individual who had no health insurance

  On January 18, CMS published a proposed rule in the Federal Register that addresses the...

• Transmittals and MLN Matters articles: CMS allows physician assistants to perform SNF level of care certifications, updated the CCI edits, and more

  On January 13, CMS published a pair of transmittals that revise Chapter 8, section 40.1 of the...

• Other issuances: None this week

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

• CMS Public Events: The transcript of the January 12 Hospital ODF is available, Physician ODF scheduled for January 24

  The transcript and audio of the Hospital & Hospital Quality Open Door Forum (ODF) conference...

• HCPro Watchdog Service

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

Issue 3, January 17, 2012

• Note: Claims processing and payment changes under the CY 2012 OPPS final rule

  The January OPPS update included a discussion of the composite payment for cardiac...

• Regulations: CMS issues final rules about adopting electronic transfers and reporting prescription drug costs

  CMS issues final rules about adopting electronic transfers and reporting prescription drug costs

• Transmittals and MLN Matters articles: CMS reminds providers about HPSA bonus payments, instructs contractors to implement ICD-10 plans, and more

  CMS reminds providers about HPSA bonus payments, instructs contractors to implement ICD-10 plans...

• Other issuances: OIG publishes review of Medicare acute care inpatient same-day readmissions at University of Pittsburgh Medical Center Presbyterian Shadyside Hospital

  On January 5, the OIG published a review stating that the University of Pittsburgh Medical Center...

• 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 2, January 10, 2012

• Note: Benefit policy changes under the CY 2012 OPPS final rule

  The only benefit policy change/clarification addressed in the January update relates to physician...

• Regulations: CMS published changes to the OPPS final rule and solicits comments for EMTALA changes

  On January 4, 2012 CMS issued several corrections to the 2012 outpatient prospective payment system...

• Transmittals and MLN Matters articles: CMS instructs teaching hospitals how to report FICA refund for medical residents

  On December 30, 2011, CMS issued a transmittal that instructs contractors to inform teaching...

• Other issuances: CMS updates NCDs

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

• CMS Public Events: Hospital Quality Open Door Forum January 12

  The next Hospital, Hospital Quality Open Door Forum (ODF) is scheduled for Thursday, January 12...

• HCPro Watchdog Service

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

Issue 1, January 3, 2012

• Note: Top five issues to watch in 2012

  Welcome back from the holidays. CMS was extremely quiet last week so I thought I’d review...

• Regulations: OIG solicits safe harbor feedback

  On December 29, the OIG published in the Federal Register its annual notice soliciting proposals...

• 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: OIG posts outpatient overpayments review

  OIG audits outpatient services payments processed by NGS

• 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...