Revenue Cycle

Important Medicare updates

Medicare Update for CAHs, October 19, 2011

OIG proposes to revise MFCU performance standards

On October 6, the OIG issued a notice seeking comment on its proposal to revise standards for assessing the performance of the State Medicaid Fraud Control Units (MFCU). This proposal would replace and supersede standards published on September 26, 1994 (59 FR 49080).

View the proposed rule

Submit a comment

OIG releases 2012 Work Plan

On October 5, the Department of Health and Human Services (HHS) released the Office of Inspector General (OIG) Work Plan for Fiscal Year 2012. The Work Plan provides brief descriptions of activities that the OIG plans to initiate or continue with respect to the HHS programs and operations of the in fiscal year 2012. 

View the 2012 Work Plan

CMS extends the deadline for submitting applications for the Bundled Payments for Care Improvement

On October 4, CMS issued a notice that extends the deadline for interested organizations to submit nonbinding letters of intent and applications for Model 1 of Bundled Payments for Care Improvement initiative. Providers must submit their letters of intent before October 6 and applications before November 18.

View the Federal Register Notice

CMS reminds providers of HIPAA 5010 deadlines

On October 3, CMS issued a special edition MLN Matters article to reminding all HIPAA covered entities that beginning January 1, 2012, all electronic claims, eligibility and claim status inquiries, must use Versions 5010 or D.0. Version 4010/5.1.

View the Special Edition MLN Matters article

CMS announces claim status codes updates

On September 30, CMS issued a transmittal stating that the national Code Maintenance Committee has updated the claim status category codes and claim status codes during the October 2011 meeting. The revised codes will be posted to on or about November 1.

Effective date: January 1, 2012

Implementation date: January 3, 2012

View the transmittal

CMS updates Medicare Claims Processing Manual to include MMEA provisions

On September 30, CMS issued a transmittal that updates the Internet Only Manual, Pub. 100-04, Chapter 15-Ambulance, to include the correct extension dates per the Medicare and Medicaid Extenders Act of 2010 (MMEA).

Effective date: January 3, 2012

Implementation date: January 3, 2012

View the transmittal  

CMS makes minor revisions to Provider Reimbursement Manual

On September 30, CMS issued a transmittal explaining the minor descriptive language and grammar revisions it made to portions of the Part 1, Chapter 9, of the Provider Reimbursement Manual.

View the transmittal

CMS issues guidance for billing QMBs

On September 28, CMS issued a Special Edition MLN Matters article to provide to Medicare providers serving QMBs, reminding them that they may not bill QMBs for Medicare cost-sharing.

View the Special Edition MLN Matters article

CMS publishes Comprehensive Primary Care Initiative fact sheet

On September 28, CMS published a fact sheet explaining The Comprehensive Primary Care Initiative. The initiative will help primary care practices deliver higher quality, better coordinated, and more patient-centered care.

Read the fact sheet

CMS updates payment rates for swing-bed hospitals

On September 27, CMS issued a transmittal that adds Table 23 to update the Medicare Payment Rates for routine SNF-type services by swing-bed hospitals during calendar year 2012.

Effective date: July 5, 2011
Implementation date: July 5, 2011
View the transmittal.

DOJ settles with Guidant for $9.25 million over allegations they didn't give device credits to hospitals

On September 26, the United States Department of Justice (DOJ) issued a release stating that Guidant LLC, a wholly owned subsidiary of Boston Scientific Corp. of Natick, Mass., has agreed to pay the United States $9.25 million to resolve allegations that it knowingly failed to give warranty credits and rebates for pacemakers and defibrilators.

View the DOJ press release

CMS extends mandatory use date for revised ABN to January 1, 2012

On September 20, CMS extended the mandatory use date for the latest version of the ABN (with the release date of 3/2011 printed in the lower left hand corner) to January 1, 2012. The extension allows providers and suppliers time to transition to using the newly posted notice. All ABNs with the release date of 3/2008 that are issued on or after January 1, 2012 will be considered invalid.

View the revised ABN
CMS updates NCDs

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

View the new lab NCD manual.

CMS requests potential NCD topics

CMS is inviting providers to share concerns about items and services they believe may be inappropriately used (i.e., underused, overused, or misused) or provide minimal benefit in hospitals, clinics, emergency departments, doctors’ offices, or in other healthcare settings. CMS hopes to use the input to create a new list of potential NCD topics, which may eventually become new NCDs.

Read more

OIG adds two new corporate integrity agreements to the CIA list

The OIG added Chaim Chaimowitz and Select Medical Corporation to its list of corporate integrity agreements (CIA).

View the list

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