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CMS publishes rates, deductibles for 2010
On October 22, CMS published in the Federal Register three notices to announce the inpatient hospital deductible, Part A premium, and Medicare Part B monthly actuarial rates, premium rate, and annual deductible for 2010.
View the notice regarding the inpatient hospital deductible for 2010.
Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the author of this week’s note from the instructor.
CMS recently announced the CY2010 Medicare Part A deductible for inpatient hospital services. When a patient is admitted as an inpatient, the deductible will increase from $1,068 in 2009 to $1,100 in 2010. In addition, beneficiaries will pay an additional daily coinsurance of $275 for days 61 through 90 and $550 for lifetime reserve days. For 2009, the corresponding amounts are $267 and $534, respectively.
CMS issues reasonable charge update
On October 23, CMS issued a transmittal to update the reasonable charge for splints, casts, dialysis supplies, dialysis equipment, and certain intraocular lenses.
Effective date: January 1, 2010
Implementation date: January 4, 2010
CMS replaces previous instructions for coverage of IRF services
On October 23, CMS issued a transmittal in which it replaced previous manual sections that describe coverage of inpatient rehabilitation services provided in inpatient rehabilitation facilities (IRF). CMS made the changes pursuant to recent regulatory changes that can be found in 42 CFR 412.622 (74 FR 39762 (August 7, 2009)).
Effective date: For IRF discharges occurring on or after January 1, 2010
Implementation date: January 4, 2010
CMS clarifies role in obtaining OCR clearance
On October 16, CMS issued a transmittal in which it made revisions to the State Operations Manual sections regarding ascertaining compliance with the Office for Civil Rights (OCR) requirements.
Effective date: October 16, 2009
Implementation date: October 16, 2009
CMS updates clotting factor furnishing fee
On October 16, CMS issued its annual update to the clotting factor furnishing fee.
Effective date: January 1, 2010
Implementation date: January 4, 2010
View a related MLN Matters article.
View a related Job Aid article.
CMS updates overpayment/underpayment interest rate
On October 15, CMS implemented the quarterly update to its interest rate for Medicare overpayments and underpayments. CMS instructed contractors to implement an interest rate of 10.875 percent effective October 22, 2009.
Effective date: October 22, 2009
Implementation date: October 22, 2009
CMS updates FDG PET transmittals
On October 16, CMS rescinded and replaced previous transmittals on its new coverage framework for FDG PET for solid tumors and myeloma. The effective date has been changed to April 3, 2009, and the implementation date has been changed to October 30, 2009. Some business requirements have been revised. All other information remains the same.
Effective date: April 30, 2009
Implementation date: October 30, 2009
View the transmittal to the NCD Manual.
View the transmittal to the Claims Processing Manual.
View a related MLN Matters article.
CMS updates 5010 transmittal
On October 16, CMS rescinded and replaced a previous transmittal that instructs the Medicare Administrative Contractors and the Shared System Maintainers to implement the changes in version 5010 of transaction 835 - Health Care Claim/Payment Advice and Updated Standard Paper Remit (SPR).
Effective date: January 1, 2010
Implementation Date: January 4, 2010 for A/B MACs, DME MACs, and FISS; January 4, 2010 and April 5, 2010 for VMS; July 5, 2010 for MCS
CMS reconsiders blanket non-coverage of MRI for blood flow determination
On October 16, CMS issued transmittals finding that the blanket non-coverage of MRI for blood flow determination at section 220.2 of the NCD Manual is no longer supported by the available evidence. Therefore, CMS is removing the phrase “blood flow measurement” from the NCD, giving local Medicare contractors discretion to cover (or not cover) this.
Effective date: September 28, 2009
Implementation date: January 4, 2010
View the transmittal to the Claims Processing manual.
Other Issuances: OIG audits Epogen, oxaliplatin, Region B RAC updates issues, and more
CGI updates approved audit issues
CGI Federal, the RAC for Region B, has posted an updated list of approved audit issues.
OIG audits Epogen payments
On October 8, the OIG issued two audit reports on payments for Epogen administration at University of Virginia Medical Center–Lynchburg Dialysis and Bon Secours Baltimore Hospital Renal Dialysis Center. The OIG found that the facilities did not meet Medicare payment requirements for some dates of service and that policies and procedures were not always followed.
OIG audits oxaliplatin payments
On October 7, the OIG issued an audit report of payments for oxaliplatin administration made during 2005 by National Government Services (NGS), a Medicare fiscal intermediary for West Virginia. The OIG determined that NGS made overpayments totaling $433,000 for oxaliplatin drug services.
CMS posts new RAC FAQ
Will Code N432 appear on the remittance advice for Recovery Audit Contractor (RAC) adjusted claims?
Editor’s note: Judith Kares, JD, CPC, regulatory specialist for HCPro, Inc., is the author of this week’s note from the instructor.
Now that CMS has implemented a permanent and nationwide Recovery Audit Contractor (RAC) Program, as authorized by the Tax Relief and Healthcare Act of 2006, hospitals need to keep themselves informed about the issues that have been approved for review in their region. Going forward, the four regional RACs will continue to review claims on a post-payment basis, using standard Medicare policies. They will be limited, however, to a three-year look-back period, with no review of claims paid prior to October 1, 2007.
Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the author of this week’s note from the instructor.
In last week’s note, we looked at the OIG Work Plan for Fiscal Year 2010. There were many issues listed for both Part A and Part B that will be on the radar for a targeted review. Hospitals are encouraged to closely examine the OIG Work Plan as part of their annual compliance program review process.
In addition, reviewing OIG audits can help hospitals and physicians identify some challenging areas within their own operations. This week, CMS published Transmittal 574 that focused on four recent OIG reports:
- Part B Chemotherapy Administration Payment and Policy;
- Prevalence and Qualifications of Nonphysicians Who Perform Medicare Physician Services;
- Inappropriate Medicare Payments for Chiropractic Services; and,
- Part B Billing for Ultrasound.
OIG issues review of CERT program
On September 29, the OIG issued an audit report on the Comprehensive Error Rate Testing (CERT) program.
HDI updates approved audit issues
HealthDataInsights (HDI), the region D RAC, has updated its list of approved audit issues.
Frequently asked questions
CMS posted several new/updated frequently asked questions (FAQ).
CMS strengthens program safeguards
On October 9, CMS issued a transmittal referencing several OIG reports that highlighted Medicare’s vulnerability to questionable claims. CMS instructed contractors to review claims data, especially for those services audited by the OIG.
Effective date: November 9, 2009
Implementation date: November 9, 2009
CMS rescinds and replaces “Pickle Amendment” transmittal
On October 9, CMS rescinded and replaced a previous transmittal regarding the status verification of all hospitals receiving disproportionate share hospital, or DSH, payments under 42 CFR Section 412.106(c)(2), also known as the "Pickle Amendment."
Effective date: October 5, 2009
Implementation date: October 5, 2009
MLN Matters articles
CMS released a special edition MLN Matters article.
CMS also released an MLN Matters article related to a transmittal previously outlined in Medicare Weekly Update.
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