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Medicare Insider

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 Insider

Issue 48, December 3, 2013

• Note from the instructor: OPPS final rule released

  Just in time for Thanksgiving, CMS released the Outpatient Prospective Payment System (OPPS) final...

• The week in Medicare updates

  This week’s updates include final rules for hospital outpatient services, physician services...

Issue 47, November 26, 2013

• Note from the instructor: Deadlines approach for hospital attestations for FY 2013

  Under the Medicare EHR Incentive Program, November 30, 2013 is the last day for eligible hospitals...

• The week in Medicare updates

  This week’s updates include changes to the FY 2014 IPPS and LTCH, and more. Click the link...

• Recent Recovery Auditor activity

  Performant Recovery posted new items to its CMS approved list. Click the link above to read about...

• Upcoming events

  CMS is hosting Open Door Forums and National Provider calls in December. Click the link above for...

Issue 46, November 19, 2013

• Note from the instructor: CMS releases Medicare Parts A and B deductible, coinsurance, and premium amounts for CY 2014

  In a recent transmittal (R82GI), CMS published updated beneficiary cost-sharing and premium...

• The week in Medicare updates

  This week’s updates include use of CARC code 23, suspension of postpayment patient status...

• Recent Recovery Auditor activity

   No new items have been posted this week. 

• Upcoming events

  CMS is hosting Open Door Forums and National Provider calls in November. Click the link above for...

Issue 45, November 12, 2013

• Note from the Instructor: CMS gives further guidance on 2-midnight benchmark in Open Door Forum

  On November 12, CMS conducted an Open Door Forum call continuing to give guidance on the 2-midnight...

• The week in Medicare updates

  This week’s updates include reassignment to Part A Critical Access Hospitals (CAH) billing...

• Recent Recovery Auditor activity

  Performant Recovery and HDI posted new items this week. Click the link above to read about the...

• Upcoming events

  CMS is hosting three Open Door Forums and two National Provider calls in November. Click the link...

Issue 44, November 5, 2013

• Note from the Instructor: CMS Updates Inpatient Hospital Reviews Website

  On September 28, CMS held a special open door forum call on the 2-midnights benchmark and its...

• The week in Medicare updates

  This week’s updates include more guidance on the 2-midnight hospital inpatient rule, and...

• Recent Recovery Auditor activity

   There are no new items this week.

Issue 43, October 29, 2013

• The week in Medicare updates

  This week’s updates include a new interest rate for Medicare overpayments and underpayments...

• Recent Recovery Auditor activity

  Connolly posted two new issues to its CMS approved list for providers. Click the link above to read...

• Wanted: Physician certification template

  I’ve received several requests over the past few weeks for a physician certification form (to...

Issue 42, October 22, 2013

• Note from the instructor: CMS issues guidance on hospital inpatient admission order and certification requirements, Part II: Physician order

  As a condition of payment under Medicare Part A, relevant law requires physician certification as...

• The week in Medicare updates

  This week’s updates include changes to the VMS and MCS prepayment review reports, a...

• Recent Recovery Auditor activity

  Performant posted two new issues to its CMS approved list for providers. Click the link above to...

• Upcoming events

  CMS is hosting a National Provider Call in November. Click the link above for registration...

Issue 41, October 15, 2013

• Note from the instructor: CMS issues guidance on hospital inpatient admission order and certification requirements, Part I: Physician certification

  As part of its efforts to clarify issues surrounding hospital inpatient admission criteria, CMS...

• CAHs and the 90-Day Implementation Period for the 2-Midnight Benchmark

  Last week, Kimberly discussed the implementation period for the 2-midnight benchmark for hospitals...

• The week in Medicare updates

   There are no new updates this week. 

Issue 40, October 8, 2013

• Note from the instructor: 90-Day Implementation Period for 2-Midnight Benchmark

  On September 28th, the Centers for Medicare and Medicaid Services (CMS) held another special open...

• The week in Medicare updates

  This week’s updates include changes to certain cost reporting procedures related to...

• Recent Recovery Auditor activity

   No new items have been posted this week. 

Issue 39, October 1, 2013

• The week in Medicare updates

  This week’s updates include a proposed rule for a Medicare Prospective Payment System for...

• Recent Recovery Auditor activity

  Performant posted one new item to its CMS approved list. Click the link above to read about the...

Issue 38, September 24, 2013

• The week in Medicare updates

  This week’s updates include home health agency reporting requirements for the certifying...

• Recent Recovery Auditor activity

  CGI and Connolly posted new items to their CMS approved lists. Click the link above to read about...

• Upcoming events

  CMS is hosting an Open Door Forum this week on Final Rule CMS – 1599F. Click the link above...

Issue 37, September 17, 2013

• The week in Medicare updates

  This week’s updates include instructions for the Home Health Change of Care Notice (HHCCN...

• Recent Recovery Auditor activity

  No new items have been posted this week.

• CMS releases two transmittals for CAH Conditions of Participation

  Recently, the OIG issued a report indicating approximately two-thirds of the critical access...

• Upcoming events

  CMS is hosting a National Provider Call next week on 2012 quality and resource use reports. Click...

Issue 36, September 10, 2013

• Medicare Compliance Forum: October 3-4

  CMS just released the FY2014 IPPS final rule, which includes some of the biggest regulatory...

• The week in Medicare updates

  This week’s updates include FY 2014 IPPS and Long Term Care Hospital PPS changes, revisions...

• Recent Recovery Auditor activity

  Performant Recovery posted new issues to its CMS approved list for providers.Click the link above...

Issue 35, September 3, 2013

• Note from the instructor: FY2014 IPPS payment adjustments and preparation for future changes, Part III: The Hospital-acquired Condition Reduction Program (HACRP)

  This is the third in a three-part series focusing on certain adjustments to reimbursement for...

• The week in Medicare updates

  This week’s updates include a Special Edition article regarding open payments, and updates to...

• Recent Recovery Auditor activity

  No new items have been posted this week. 

• Upcoming events

  CMS is hosting an Open Door Forum in September on electronic clinical template for lower limb...

Issue 34, August 27, 2013

• Note from the instructor: FY 2014 IPPS payment adjustments and preparation for future changes, Part II: the Hospital Value-based Purchasing Program

  This is the second note in a three-part series focusing on certain adjustments to reimbursement for...

• The week in Medicare updates

  This week’s updates include updates to the Ambulatory Surgery Center payment system. Click...

• Recent Recovery Auditor activity

  HDI posted an item to its CMS approved list for providers. Click the link above to read about the...

• Medicare Compliance Forum: October 3-4

  CMS just released the FY2014 IPPS final rule, which includes some of the biggest regulatory changes...

Issue 33, August 20, 2013

• Note from the instructor: FY 2014 IPPS Final Rule adjustments and preparation (Part I): The Hospital Readmission Reduction Program

  Over the next three issues of Medicare Insider, we will review adjustments to certain...

• Most Critical Access Hospitals would not meet the location requirements if required to re-enroll in Medicare

  On August 15, the OIG issued a report stating that nearly two-thirds of critical access hospitals...

• The week in Medicare updates

  This week’s updates include changes to the Inpatient Psychiatric Facilities Prospective...

• Recent Recovery Auditor activity

  Performant Recovery and CGI posted items to their CMS approved list for providers. Click the link...

• Upcoming events

  CMS is hosting an Open Door Forum in September on electronic clinical template for lower limb...

Issue 32, August 13, 2013

• The week in Medicare updates

  This week’s Medicare updates include revisions to the ViPS Medicare system diagnosis code...

• Recent Recovery Auditor activity

  Performant Recovery posted items to its CMS approved list for providers. Click the link above to...

• Upcoming events

  CMS will host National Provider calls and will hold its second semi-annual meeting of the advisory...

Issue 31, August 6, 2013

• Note from the instructor: FY2014 IPPS Final Rule

  It is Friday, August 2, and the clock is just about to chime and announce the weekend has arrived...

• The week in Medicare updates

  This week’s Medicare updates include the FY2014 IPPS final rule, updates to the wage index...

• Recent Recovery Auditor activity

  Performant, CGI, Connolly, and HDI all posted items to their CMS approved list for providers. Click...

• Part-time Medicare/billing instructors

  HCPro is seeking part-time adjunct Medicare/Billing regulatory specialists to serve as instructors...

• Full-time or part-time coding instructors

  HCPro is seeking Coding Education Specialists to serve as instructors for ICD-10-related boot...

Issue 30, July 30, 2013

• Note from the instructor: On the road to a more prospective OPPS, part II

  Under the proposed CY 2014 OPPS/ASC rule, CMS has proposed to significantly expand the number and...

• The week in Medicare updates

  Updates for this week include Type of Service corrections, revisions to the ViPS Medicare System...

• Recent Recovery Auditor activity

  CGI posted two new issues to its CMS approved list. Click the link above to read about the issue...

Issue 28, July 16, 2013

• OPPS and MPFS proposed rules will impact CAHs

  In last week’s Medicare Insider article, Kimberly Hoy, JD, wrote about the newly published...

• Note from the instructor: On the road to a more prospective OPPS

  Since August 2000, the outpatient prosepctive payment system (OPPS) has been the primary payment...

• The week in Medicare updates

  This week’s Medicare updates include a new interest rate for Medicare overpayments and...

• The week in Medicare updates

  This week’s Medicare updates include an OIG advisory opinion regarding equity interest for...

• Recent Recovery Auditor activity

  Performant Recovery posted one new issue to its CMS approved list for providers. Click the link...

• Upcoming events

  CMS will host National Provider calls and its second semi-annual meeting of the advisory panel on...

• Upcoming events

  CMS will host National Provider calls in July and August, and will hold its second semi-annual...

Issue 27, July 9, 2013

• Note from the instructor: OPPS proposed rule on display

  If you thought the two-midnight rule in the Inpatient Prospective Payment System (IPPS) proposed...

• The week in Medicare updates

  This week’s Medicare updates include a proposed rule regarding Home Health Prospective...

• Recent Recovery Auditor activity

  Performant and CGI posted new issues. Click the link above to read about the issue and see which...

• Upcoming events

  CMS will host National Provider calls in July, and will hold its second semi-annual meeting of the...

Issue 26, July 2, 2013

• Note from the instructor: General guidelines for keeping up-to-date with changing regulatory requirements

  One of the biggest challenges to the provider community, including hospitals and CAHs, is keeping...

• The week in Medicare updates

  This week’s Medicare updates include updates to coding requirements for lab specimen...

• Recent Recovery Auditor activity

  HDI posted a new issue. Click the link above to read about the issue and see which states are...

Issue 25, June 25, 2013

• Note from the instructor: Limitations on liability for therapy limit denials

  We are now nearly six months into the revisions of the payment liability for therapy services in...

• The week in Medicare updates

  This week’s Medicare updates include updates to coding requirements for lab specimen...

• Recent Recovery Auditor activity

  Performant, CGI, Connolly, and HDI posted new issues. Click the link above to read about the issues...

Issue 24, June 18, 2013

• Note from the instructor: OIG report on usage of financial liability "G" modifiers

  The OIG recently released a report on problems with how Medicare contractors process claims with...

• The week in Medicare updates

  This week’s Medicare updates include an annual update of ICD-9-CM, new non-physician...

• Recent Recovery Auditor activity

  Performant, Connolly, and HDI posted new issues. Click the link above to read about the issues and...

• Upcoming events

  CMS will host National Provider calls in June and July, two Open Door Forums this week, and is...

Issue 23, June 11, 2013

• The week in Medicare updates

  This week’s Medicare updates include pass-through payments for CRNA anesthesia services and...

• Recent Recovery Auditor activity

  Performant and Connolly posted new issues. Click the link above to read about the issues and see...

• Upcoming events

  CMS will host National Provider calls in June and July, and is seeking comments on proposed...

Issue 22, June 4, 2013

• Note from the instructor: CMS releases information on the National Physician Payment Transparency Program: Open Payments

  CMS recently issued Special Edition MLN Matters article SE1303, which is designed to inform...

• The week in Medicare updates

  This week’s Medicare updates include quarterly updates to the DMEPOS competitive bidding...

• Recent Recovery Auditor activity

  Performant and HDI posted new issues. Click the link above to read about the issues and see which...

• Upcoming events

  CMS will host National Provider calls in June and July, and is seeking comments on proposed...

Issue 21, May 29, 2013

• TOB 85X Medically Unlikely Edit claims adjudication change

  At this time, CAH Method II providers who received some MUE claim denials for a claim line with a...

• Resource available for CAH II physicians eligible to participate in the Medicare EHR incentive program

  Physicians who assign their reimbursement and billing to a Critical Access Hospital (CAH) under...

• The week in Medicare updates

  This week’s Medicare updates include information on the National Physician Payment...

• Recent Recovery Auditor activity

  Connolly and HDI posted new issues. Click the link above to read about the issues and see which...

• Recent Recovery Auditor activity

  Performant and HDI posted new issues. Click the link above to read about the issues and see which...

• Upcoming events

  CMS will host National Provider calls in June and July, and an Open Door Forum in May. Click the...

Issue 20, May 21, 2013

• Note from the instructor: CMS clarifies payment amount to be applied to payment caps and manual review thresholds for outpatient therapy services provided by critical access hosptials

  In a recent Transmittal (R1216OTN) and related MLN Matters Article (MM8278), CMS clarified that...

• The week in Medicare updates

  This week’s Medicare updates include a requirement for sending immediate advisements to the...

Issue 19, May 14, 2013

• The week in Medicare updates

  This week’s Medicare updates include new HCPCS codes for customized DME, quarterly updates to...

• Recent Recovery Auditor activity

  Connolly posted new issues. Click the link above to read about the issues and see which states are...

• Upcoming events

  CMS will host HCPCS Public Meetings and National Provider calls in May and June, Click the link...

• Applying multiple procedure payment reductions to therapy cap amounts for Critical Access Hospital (CAH) claims

  The American Taxpayer Relief Act of 2012 included provisions affecting the outpatient therapy caps...

Issue 18, May 7, 2013

• Note from the Instructor: Guidance on Implementing Sequestration under the Medicare Fee-for-Service Program

  A number of hospitals and other providers have been asking CMS for additional guidance on the...

• The week in Medicare updates

  This week’s Medicare updates include updated FAQs, and two proposed rules regarding FY2014...

• Recent Recovery Auditor activity

  Performant and Connolly posted new issues. Click the link above to read about the issues and see...

• Upcoming events

  CMS will host HCPCS Public Meetings in May and June, Click the link above for registration...

Issue 17, April 30, 2013

• Note from the instructor: CMS issues proposed IPPS/LTCH rule for FY 2014

  On April 26, CMS issued a proposed rule that would update FY 2014 Medicare payment policies and...

• The week in Medicare updates

  Highlights of the past week’s Medicare updates include a proposed rule from CMS on inpatient...

• Recent Recovery Auditor activity

  Performant and Connolly posted new issues, plus news on CMS' plans to restructure the RAC program...

• Upcoming events

  CMS will host a SNF/LTC Open Door Forum  the first week of May, and an HCPCS Public Meeting on...

• Changes for Outpatient Laboratory Services Rendered in a Critical Access Hospital (CAH)

  Patients presenting to Critical Access Hospitals (CAHs) will encounter a change in their...

Issue 16, April 23, 2013

• Note from the instructor: More Changes for Medically Unlikely Edits (MUEs)

  CMS and providers have had a love/hate relationship with Medically Unlikely Edits (MUEs), and are...

• The week in Medicare updates

  Highlights of the past week’s Medicare updates include one proposed rule from the OIG on...

• Recent Recovery Auditor activity

  Performant posted new issues. Click the link above to read about the issues and see which states...

• Upcoming events

  CMS will host state-by-state calls in Federally-facilitated and State Partnership Marketplace...

Issue 15, April 16, 2013

• Note from the instructor: CMS releases additional guidance on Part A to B rebilling

  CMS has released several documents regarding the rule change that allows for full Part B payment...

• The week in Medicare updates

  Highlights of the past week’s Medicare updates include two proposed rules: one from the OIG...

• Recent Recovery Auditor activity

  Performant Recovery, CGI, and Connolly all posted new issues. Click the link above to read about...

• Upcoming events

  CMS will host state-by-state calls in Federally-facilitated and State Partnership Marketplace...

Issue 14, April 9, 2013

• Note from the instructor: CMS continues to provide updates on the Medicare and Medicaid EHR Incentive Programs

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• The week in Medicare updates

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• Recent Recovery Auditor activity

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• Upcoming events

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Issue 13, April 2, 2013

• Note from the instructor: Manual medical review by Recovery Auditors of outpatient therapy claims begins April 1

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• The week in Medicare updates

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• CMS issues final rule on requirements for LTC facilities notices of closure

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• Recent Recovery Auditor activity

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• Upcoming events

  CMS will hold three national provider calls in April. Click the link above to learn more!

Issue 12, March 26, 2013

• Note from the instructor: Details released on Part A to B rebilling ruling

  Most of you reading this likely already know that CMS released a ruling on March 13 that revises...

• The week in Medicare updates

  Highlights of the past week’s Medicare updates include the accompanying transmittal for the...

• Medicare Audit Improvement Act reintroduced, AHIMA shows support

  The Medicare Audit Improvement Act, which aims to rectify problems identified in the Recovery...

• Recent Recovery Auditor activity

  Performant Recovery, CGI, and Connolly all have newly added Recovery Auditor issues, including...

• Upcoming events

  CMS will hold two national provider calls in April on the Medicare Shared Savings Program. Click...

Issue 11, March 19, 2013

• CMS issues proposed changes to Part B inpatient billing in hospitals

  Effective Wednesday March 13, hospitals denied payment because a Part A inpatient stay was deemed...

• Important Medicare Updates

  This past week’s updates includes the notice of ruling and proposed rule on Part B billing in...

• CMS instructs on Taxpayer Relief Act and sequestration impact on CAHs

  During the March 7 Rural Health Open Door Forum, CMS discussed a number of items that have an...

• Recent Recovery Auditor Activity

  Performant Recovery posted four new issues across three categories, Connolly posted a new issue for...

• Upcoming events

  CMS will hold open door forums on March 19 (Ambulance) and March 21 (Skilled nursing...

Issue 1, July 19, 2013

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• Nov 12 ODF recording

   Nov 12 ODF recording