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CMS issues national coverage determination (NCD) for percutaneous transluminal angioplasty (PTA)
On January 26, CMS issued an NCD for PTA in which, consistent with its previously issued decision memo, it made no changes to coverage.
Q: Where can I find more information about CMS’ recent report on ICD-10?
A: CMS released its most recent report on December 29, 2008. The report summarizes CMS’ one-year project with AHIMA to identify and assess the various effects of ICD-10, particularly the anticipated effect of the new coding system on business processes, systems, and operations under CMS’ direct responsibility. The AHIMA project was the first of several phases leading up to a more defined ICD-10 implementation plan within the coming year, according to a December 29 CMS memorandum that announced the report.
To read the report, click here.
Q: I wasn’t able to listen to the most recent CMS conference calls about ICD-10. Do you know where I can find more information about these calls?
A: CMS has posted on its Web site transcripts of the ICD-10-CM/PCS conference calls it sponsored for hospital staff members and other Part A and Part B providers in October and November, 2008. For more information, click here.
Editor’s note: To sign up for HCPro’s January 27 audio conference “ICD-10: Develop a Blueprint for Implementation,” click here.
Q: I am looking for information about when to code oxygen therapy. For example, can I code it when a patient is admitted with acute bronchitis with acute exacerbation of chronic obstructive pulmonary disorder? Also, should I routinely report physical and occupational therapy codes on inpatient records?
A: If your facility would like to collect data regarding oxygen therapy, it would be appropriate to code it. If your facility has a rehabilitation unit, it would be appropriate to report the physical and occupational therapy service codes. This would help show the intensity of service.
Editor’s note: Sandy Sillman, RHIT, PAHM, DRG coordinator at Henry Ford Health System in Detroit, answered this question that appeared in the December issue of Briefings on Coding Compliance Strategies. For more information, click here.
The governor of Minnesota faces a dilemma because of the growing number of Medicaid-eligible patients in his state, the Minneapolis Star Tribune reports.
Governor Tim Pawlenty’s budget includes a $3 billion share for Medicaid, which is one-fifth of his budget. But cutting isn’t easy. He has a Legislature that wants to expand access to healthcare for the poor.
Read the full story in the Tribune.
A recent report by the Center for Studying Health System Change, a nonpartisan policy research organization, states that one in seven Americans under age 65 went without a prescription drug in 2007 because they could not afford it. The study shows the effect increased drug prices were having even before the economic recession went into full swing: in 2003, only one in 10 Americans said they couldn’t afford their prescriptions.
According to the study, people who were most likely to be unable to afford their prescriptions were uninsured and suffering from a chronic condition. Without their medications, their conditions were likely to worsen, causing them to seek expensive medical treatment.
However, in the recent survey, insured Americans were not immune to prescription pricing troubles. One in 10 Americans insured by their employer reported going without a prescription because of cost, also up from the last study in 2003.
Source: The New York Times
Nine out of 10 hospitals reported that borrowing money has become harder due to the economic recession, and the same number report that obtaining charitable funds has also become more difficult, according to the American Hospital Association (AHA).
A recent survey of 639 hospital CEOs showed that because of the lack of access to capital, hospitals have had to put projects on hold:
- 82% have put facility projects on hold
- 65% have put clinical technology projects on hold
- 62% have put information technology projects on hold
Putting projects on hold hinders hospitals’ ability to continually increase quality and efficient care, and to respond to community needs.
By Jackie Birmingham, RN, BSN, MS, CMAC.
A Medicare beneficiary (or authorized representative) who has been given an Advance Beneficiary Notice of Noncoverage (ABN) may elect to receive the item or service anyway. In this case, the beneficiary should indicate that he or she is willing to be personally and fully responsible for payment by marking options 1 or 2 in box G on the ABN form. This new version of the ABN is used before services are rendered (as the name implies) and it may be given by outpatient department staff.
Here are some more tips regarding filling out the ABN:
- Option 1 indicates the beneficiary or representative will pay for the service out of pocket, but the hospital will also bill Medicare to see whether Medicare will pay for the item or service. If Medicare does not pay, the patient has the opportunity to appeal, but there is no guarantee Medicare will pay for the item or service.
- Option 2 indicates the individual accepts full financial responsibility for the item or service. Medicare will not be billed, and the beneficiary cannot appeal. This option requires that the patient be informed of the cost of the service prior to receiving the service.
- When a beneficiary decides to decline an item or service, he or she should indicate this by marking option 3 in box G on the ABN form. Counseling the patient on this decision and documenting the discussion is important. The service has been ordered based on the patient’s physician’s advice, and if the patient declines the item or service, it is important to be sure that he or she is fully informed of the consequences of the decision.
- The beneficiary cannot refuse to sign the ABN and still demand the item or service.
- If a beneficiary refuses to sign a properly executed ABN, the notifier should consider not furnishing the item or service, unless the consequences (health and safety of the patient, or civil liability in case of harm) are such that this is not an option.
- Additionally, the notifier may annotate the ABN, and have the annotation witnessed, indicating the circumstances and persons involved.
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