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  This week CMS rescinded and replaced the January (outpatient prospective payment system) OPPS...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