Revenue Cycle

Important Medicare updates

Medicare Update for CAHs, May 2, 2012

CMS continues updates to Program Integrity Manual

CMS issued two transmittals this past week that continue its process of updating chapter 15 of the Program Integrity Manual.

View the April 6 transmittal 

View the April 13 transmittal 

CMS adds new test to list of CLIA waived tests

On April 6, CMS issued two transmittals that update the CLIA waived test list. CMS issued a second transmittal on the same date to include a test that was not included in the original transmittal (86386QW Nuclear Matrix Protein 22 (NMP22), qualitative).  

Effective Date: January 1, 2012

Implementation Date: July 2, 2012

View the transmittal

View the transmittal 

CMS offers guidance for correct claims submission when secondary payers are involved

On April 11, CMS issued a special edition MLN Matters article that explains how providers should bill services for Medicare beneficiaries with secondary insurance.

View the special edition MLN Matters article 

OIG issues report on claim modifier –KX

On April 20, the OIG issued a report on the –KX modifier, which indicates that a claim meets Medicare coverage criteria and the supplier has the required documentation on file. The report found that the modifier is not effective in ensuring that suppliers of DMEPOS that submitted Medicare claims had the required supporting documentation on file. The  OIG estimates that contractors paid approximately $316.4 million to suppliers that did not have the required documentation on file to support the DMEPOS items with 2007 dates of service.

View the OIG report.

HHS issues administrative simplification proposed rule

On April 17, HHS issued a proposed rule in the Federal Register that would implement section 1104 of the Affordable Care Act by establishing new requirements for administrative transactions that would improve the utility of the existing HIPAA transactions and reduce administrative burden and costs. This rule also proposes to change the official compliance date for ICD-10 from October 1, 2013 to October 1, 2014.

View the proposed rule.

View an HCPro article on the ICD-10 delay.

Submit a comment.

CMS issues technical corrections to EHR Incentive Program—Stage 2 proposed rule

On April 18, CMS issued technical and typographical errors to the proposed rule entitled ‘‘Medicare and Medicaid Programs; Electronic Health Record Incentive Program—Stage 2’’ which appeared in the March 7, 2012.

View the corrections.

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