Revenue Cycle

Important Medicare updates

Medicare Update for CAHs, January 11, 2012


CMS creates CO-OP program to expand health plans  

On December 13, CMS issued a final rule in the Federal Register that implements the Consumer Operated and Oriented Plan (CO-OP) program, which provides loans to foster the creation of consumer-governed, private, nonprofit health insurance issuers to offer qualified health plans in the Affordable Insurance Exchanges (Exchanges). 

View the Federal Register

CMS updates Medicare deductible, coinsurance and premium rates for 2012 to correct a date

On December 16, CMS rescinded Transmittal 72, dated November 18, 2011, and replaced it with Transmittal 74. The new transmittal corrects the year from 1996 to 1966, in the table in section 20.2 - Part B Annual Deductible. All other information remains the same.

Effective Date: January 1, 2012

Implementation Date: January 3, 2012 

View the transmittal

CMS publishes January 2012 I/OCE specifications version 13.0

On December 16, CMS issued its recurring update to provide instructions and specifications for the Integrated Outpatient Code Editor (I/OCE) that will be utilized under the OPPS and Non-OPPS for hospital outpatient departments, community mental health centers, all non-OPPS providers, and for limited services when provided in a home health agency not under the Home Health Prospective Payment System or to a hospice patient for the treatment of a non-terminal illness. 

Effective Date: January 1, 2012

Implementation Date: January 3, 2012 

View the transmittal 

CMS issues off-cycle release of the IPPS FY 2012 Pricer

On December 9, CMS issued a transmittal that corrects a code for the new technology add-on for Fiscal Year 2012 and makes changes to the classifications of certain diagnosis related group (DRG) in the current and prior years. 

Effective Date: October 1, 2011

Implementation Date: January 3, 2012

View the transmittal 

CMS updates the laboratory fee schedule 

On December 9, CMS issued a transmittal that provides instructions for the CY 2012 clinical laboratory fee schedule, mapping for new codes for clinical laboratory tests, and updates for laboratory costs subject to the reasonable charge payment.

View the transmittal 

CMS posts information about preventive services educational resources

On December 15, CMS posted a Special Edition MLN Matters article that lists the resources that are available to help providers educate patients about preventive services.

View the Special Edition MLN Matters article

OIG posts outpatient overpayments review

The OIG posted a review of Medicare payments exceeding charges for outpatient services processed by National Government Services (NGS) in Jurisdiction 6 (Illinois and Wisconsin) for the period January 1, 2006, through June 30, 2009.

Read the OIG report

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