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Regulatory MonitoringMay 4-11 Transmittals and MLN Matters articles: CMS clarifies requirement for podiatric treatment, issues MLN Matters articles, and more
CMS Issues Instructions for Recoupment of Overpayments related to MS-DRG 956
On May 8, CMS issued instructions on the mass adjustment of claims for MS-DRG 956 (Limb Reattachment, Hip & Femur Proc. For Multiple Significant Trauma). The Inpatient Pricer had mistakenly identified this DRG as a “special-pay” post acute care transfer DRG. Payment under the “special-pay” methodology resulted in overpayments for discharges that met the criteria for the post acute care transfer rule. The mass adjustments must be completed by August 1, 2009.
Effective date: October 1, 2008
Implementation date: April 27, 2009
CMS implements Section 148 of MIPPA regarding outpatient status for a CAH
On May 8, CMS issued a transmittal providing billing instructions based on the new criteria for determining a patient’s outpatient status for a critical access hospital (CAH) or an entity provider-based to the CAH, per Section 148 of the Medicare Improvements for Patients and Providers Act of 2008.
Effective date: July 1, 2009
Implementation date: July 6, 2009
CMS clarifies requirement for podiatric treatment
On May 8, CMS issued a transmittal clarifying the requirement for podiatric treatment in Pub. 100-04, Ch. 32, § 80.8. This clarification is necessary to support podiatric coverage requirements found in Pub. 100-02, Ch. 15, § 290.
Effective date: June 8, 2009
Implementation date: June 8, 2009
CMS releases MLN Matters articles
CMS released two MLN Matters article related to a transmittal previously outlined in Medicare Weekly Update.
- Ensuring Only Clinical Trial Services Receive Fee-For-Service Payment on Claims Billed for Managed Care Beneficiaries
- Surgery for Diabetes National Coverage Determination (NCD)
CMS also released a special edition MLN Matters article.
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