All Entries in the "Latest News" Category
CMS issues IPPS proposed rule for FY2013
Inpatient acute care hospitals could see a 2.3% increase in payment rates under the fiscal year (FY) 2013 Inpatient Prospective Payment System (IPPS) proposed rule, released April 24. The 2.3% is a net update after inflation, improvements in productivity, a statutory adjustment factor, and adjustments for hospital documentation and coding changes. In addition, the IPPS proposed rule contains provisions to strengthen the Hospital Inpatient Quality Reporting (IQR) Program and proposes new policies and measures for the Hospital Value-Based Purchasing (VBP) Program. “It's good that they're lowering the burden on hospitals from tracking so many quality issues, but they're coming up with a couple other things, like [hospital-acquired conditions (HAC)],” says Robert S. Gold, MD, CEO of DCBA, Inc., in Atlanta. “If the goal is to reward excellence, hospitals have to ensure that their coders are up to speed with appropriate identification of complications and with [present on admission] POA indicators as well as the over-documentation issues that could lead to financial penalties,” Gold says. CMS also proposes a methodology to calculate the readmissions adjustment factor for inpatient hospitals that could result in a 0.3% decrease in overall payments to hospitals. Read the full story on HCPro.comRecent Recovery Auditor activity
DCS Healthcare added a new semi-automated issue for inpatient rehabilitation facility claims to its CMS-approved list for providers in New Hampshire, Massachusetts, Maine, Vermont, and Rhode Island.
CMS to resolve incorrect claims processing issue for 12X and 13X bill types
On February 24, CMS sent out an update informing providers that it has identified a Medicare claims processing issue that has been causing hospital outpatient services rendered in an institutional setting to be processed incorrectly. Specifically, the notice provided guidance on claims inappropriately overlapping when billed with a 12X or 13X type of bill with the same date of service.
CMS had previously issued guidance in Transmittal R2386CP, which clarified that providers could separately bill outpatient services rendered prior to a non-covered inpatient admission. It also states that the dividing line for services billed on the inpatient and outpatient claims is the inpatient order, and that services “prior to the point of admission” are to be billed as outpatient services with a 13X bill type. This includes services in the outpatient and emergency departments.
But many providers continued to see denied inpatient cases involving 13X bill types, according to Kimberly Anderwood Hoy, JD, CPC, director of Medicare and compliance at HCPro, Inc.
CMS requires the creation of improper payment edits
In early March, CMS released two related transmittals that rescinded prior transmittals. These rescinded transmittals summarize issues that the Recovery Auditors have identified as causing significant overpayments. CMS is requiring the implementation of edits to either correct or prevent these errors.
One Time Notification Transmittal 1051, which is effective July 1, 2012, will require the development of edits to correct improper payments for the following areas:
To read an article on this topic that appeared in HCPro’s Medicare Update For CAHs, visit our website by clicking here.
HHS proposes one-year delay of ICD-10-CM/PCS
by Andrea Kraynak, CPC
HHS released a proposed rule today announcing a one-year delay of the implementation of ICD-10-CM/PCS. If finalized, ICD-10 would become effective October 1, 2014.
“Many provider groups have expressed serious concerns about their ability to meet the Oct. 1, 2013, compliance date. The proposed change in the compliance date for ICD-10 would give providers and other covered entities more time to prepare and fully test their systems to ensure a smooth and coordinated transition to these new code sets,” according to an April 9 press release.
“This is what I expected,” says Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CPC-I, CCDS, director of HIM and coding at HCPro, Inc., in Danvers, Mass. “But I am happy to hear that they didn’t seem to consider bypassing ICD-10 and going right to ICD-11. This goes to show that they do see the value in the system.”
She believes this delay will give providers the necessary time to implement and handle the costs associated with the change. “And now that we know the deadline, there is no excuse,” she says. “At this point, we have a date in sight again and we shouldn’t waste away the time that we have. We were given the extra time; use it wisely.”
The proposed rule, “Administrative Simplification: Adoption of a Standard for a Unique Health Plan
Identifier; Addition to the National Provider Identifier Requirements; and a Change to the Compliance Date for ICD-10-CM and ICD-10-PCS Medical Data Code Sets” also proposes the adoption of a unique health plan identifier under HIPAA. That proposal would implement several administrative simplification provisions of the Affordable Care Act and save an estimated $4.6 billion over 10 years for healthcare plans and providers. The proposed rule also includes the adoption of a data element that would serve as an “other entity” identifier (OEID), as well as add a National Provider Identifier (NPI) requirement.
The proposed rule explains that three main issues emerged in recent months regarding the previous October 1, 2013 compliance date, leading HHS to reconsider the deadline:
- The transition to Version 5010 did not go as effectively as expected
- Providers were concerned about a lack of resources due to competing statutory initiatives
- Several surveys and polls showed a lack of readiness for the transition
“While we considered a number of alternatives for the delay…we believe a 1-year delay would provide sufficient time for small providers and small hospitals to become ICD-10 compliant and would be the least financially burdensome to those who had planned to be compliant on October 1, 2013,” the proposed rule states, estimating that a one-year delay would add an estimated 10%-30% to the total cost of implementation for those entities that have already spent or budgeted for the transition.
Those in the healthcare industry offered mixed reactions to the proposed length of the delay.
“It is disheartening and encouraging in many respects. Disheartening for the facilities and practices who spent the money to prepare for the October 1, 2013 deadline but encouraging for those same people to be ahead of the game now as to breathe a little easier,” says James S. Kennedy, MD, CCS, managing director of FTI Consulting in Brentwood, Tenn.
“The best way to prepare for ICD-10 implementation continues [to be] to first practice ICD-9-CM correctly and then negotiate the differences in ICD-10” Kennedy says. This [proposal could] give us another year to get our infrastructure together and fill in the documentation and coding gaps so facilities can be ready to adapt to ICD-10.”
Meanwhile Cheryl Ericson, MS, RN, clinical documentation improvement education director for HCPro Inc, points out, “This gives everyone an opportunity to slow down, take a deep breath.”
“Most organizations should maintain their current course of progress so that coders become fluent in ICD-10. This just gives everyone extra time for improvement and gives us greater opportunities to recognize weaknesses in documentation,” she says.
She notes that the 2013 compliance deadline was going to be tight for most organizations, but the delay will give everyone time to consider dual coding prior to implementation. “Take this as a blessing in disguise. Train your staff members and get them comfortable so that when the transition does come, it won’t be as stressful,” Ericson says.
Rose T. Dunn, MBA, RHIA, CPA, FACHE, chief operating officer of First Class Solutions, Inc. in Maryland Heights, Mo., and former president, board member, and interim CEO of AHIMA, is disappointed that CMS is delaying a full year and would have preferred only a six-month postponement. “I’d continue to encourage providers to prepare for ICD-10 at a calmer pace and take advantage of spreading the cost of implementation over another year,” she says.
To comment on the proposed rule, visit www.regulations.gov. Comments are due within 30 days of publication in the Federal Register. The rule is due to publish in the April 17 edition of the Federal Register.
Editor’s note: For more information, view the related Fact Sheet. A display copy of the proposed rule is available online. The original announcement of a potential delay came earlier this year in a February 16 press release.
Experts: Lack of HIPAA basics cost BCBST $18.5 million
HIPAA compliance 101—policies, training, monitoring, and risk assessments—might have saved Blue Cross Blue Shield of Tennessee (BCBST) millions, experts say.
The health insurer agreed to a $1.5 million settlement with the Office for Civil Rights (OCR) over potential HIPAA security violations and spent another $17 million in breach response costs.
On March 13, BCBST and the OCR, the government’s HIPAA privacy and security enforcer, reached the second largest financial settlement of its kind, behind CVS Caremark’s $2.25 million deal a little more than three years ago.
The agreement requires BCBST to update its HIPAA compliance policies and procedures, obtain OCR approval on all policy changes, and conduct unannounced random audits of its own employees.
This is OCR’s first enforcement action related to a breach that was reported per the Health Information Technology for Economic and Clinical Health (HITECH) Act requirements, according to a Department of Health & Human Services (HHS) press release.
Read the full story on HIPAA Update.
CMS targets April for release of new ICD-10-CM/PCS implementation date
CMS expects to release a new ICD-10-CM/PCS implementation date sometime in April. That date will be the same for payers and providers.
Recovery Auditors to increase medical records request limits
On March 12, CMS issued an update that effectively raises the additional documentation requests (ADR) limits for Recovery Auditors. Beginning March 15, 2012, ADR limits will increase to 2% of all claims submitted in the prior calendar year, divided by eight. This represents a 1% increase from 2011. In addition, the maximum number of requests per 45 days is now 400, which is an increase of 100 from last year. Providers with more than $100 million in MS-DRG payments that previously had a 45-day cap of 500 now have a new cap of 600 record requests per period. For those providers that have a calculated limit of 34 ADR requests or less, the Recovery Auditors may requests up to 35 records per 45-day period.
Other relevant announcements within the update include the fact that CMS still reserves the right to allow Recovery Auditors to exceed stated limits, at CMS’ discretion or by Recovery Auditor request. In these cases, CMS or the Recovery Auditor will notify affected provider in writing.
CMS publishes 5010 FAQs and OIG identifies $1.5 million in overpayments made to Boston hospital
CMS has posted several new FAQs about the transition to HIPAA 5010.
OIG identifies $1.5 million in overpayments made to Brigham and Women’s Hospital (MA)
On March 21, the OIG released an audit report that said Brigham and Women's Hospital, located in Boston, did not fully comply with Medicare billing requirements for 219 of the 359 claims reviewed. The incorrect billing resulted in net overpayments totaling $1.5 million for calendar years 2009 and 2010. Overpayments occurred primarily because the Hospital did not have adequate controls to prevent the incorrect billing of Medicare claims and did not fully understand Medicare billing requirements.
Recent recovery auditor activity
HealthDataInsights (HDI) added four new issues for medical necessity claims to its CMS-approved list for providers in all Region D states.
View the issues from February 27.
Connolly Healthcare added a new issue for DME non-physician – supplies claims to its CMS-approved list for suppliers who bill CIGNA Government Services.