Revenue Cycle

Important Medicare updates

Medicare Update for CAHs, October 5, 2011

MLN Matters articles
CMS released several MLN Matters articles related to previously-released transmittals.
OIG reviews medical device claims

On September 14, the OIG released a report on outpatient claims processed by Palmetto GBA that included procedures for the insertion of multiple units of the same type of medical device in calendar years 2008 and 2009. Of the 45 claims reviewed, the OIG determined that Medicare paid 13 incorrectly.

View the OIG report.

CMS instructs on drug HCPCS “hook and hold” mechanism

On September 23, CMS issued a transmittal to instruct contractors on the “hook and hold” program devised for certain drug HCPCS codes. CMS is instructing contractors to maintain and update the program each quarter based on the list of drug HCPCS found at the address provided in the business requirements section of the transmittal.

Effective date: January 1, 2012
Implementation date: January 3, 2012

View the transmittal.

CMS educates on different contractor types

CMS has released a special edition MLN Matters article to explain the different types of Medicare contractors.

View the special edition article.

CMS replaces transmittals
CMS posts update to “amount in controversy” for appeals

On September 23, CMS posted a notice in the Federal Register to announce the annual adjustment in the amount in controversy (AIC) threshold amounts for Administrative Law Judge (ALJ) hearings and judicial review under the Medicare appeals process. The calendar year 2012 AIC threshold amounts are $130 for ALJ hearings and $1,350 for judicial review.

View the Federal Register notice.

CMS issues PPS corrections

On September 26, CMS issued a series of corrections to the prospective payment systems (PPS) for acute care hospitals, inpatient rehabilitation facilities, and skilled nursing facilities.

View the IPPS correction notice.

View the IRF PPS correction notice.

View the SNF PPS correction notice.

CMS draws attention to patient rights initiative

In a press release issued September 8, CMS announced new guidance on the equal visitation and representation rules finalized last November. HHS Secretary Kathleen Sebelius said, “We are releasing guidance for enforcing new rules that give all patients, including those with same-sex partners, the right to choose who can visit them in the hospital as well as enhancing existing guidance regarding the right to choose who will help make medical decisions on their behalf.”

View the press release.

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