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The 2010 OPPS final rule released on October 30 contains few surprises, but does finalize two changes that received considerable attention when CMS proposed them.
“The information CMS has finalized for physician supervision and drug reimbursement are two key areas for hospital review, though for slightly different reasons,” says Jugna Shah, MPH, president of Nimitt Consulting in Washington, DC.
Click here to read more.
The Revenue Cycle Institute has new membership program for healthcare organizations that face challenges managing Medicare rules and regulations. The program offers ongoing access to regulatory experts for analysis, guidance, and tailored on-site education for their revenue cycle teams. Read More→
Healthcare providers are finding themselves and their reimbursement claims accountable to more and more auditors as CMS steps up its Medicare and Medicaid auditing activities. And CMS is unlikely to decrease auditing for incorrectly paid claims anytime soon; it too is being held accountable—by the Office of Inspector General (OIG).
In 2010, the OIG plans to review the progress of many Medicare and Medicaid auditing programs, as well as CMS’ oversight of several of the programs, according to the 2010 Work Plan, released October 1. Read More→
The Revenue Cycle Institute has issued a report on a nation-wide survey of hospitals about their efforts to prepare for the permanent RAC program. More than 700 hospitals nationwide participated in the survey.
While 71% of hospitals responding said they have a formal RAC preparedness program in place, the majority of programs were still in the early stages of development, focusing on initial attempts to complete risk assessments. Slightly under half of hospitals responding have designated a RAC coordinator. Most facilities have or are building RAC teams within their facilities, and the majority of those teams include a physician advisor in some capacity.
New issues for RAC Region D
HealthDataInsights (HDI) has announced two new issues for region D. HDI can now audit DME providers in all region D states for the following two issues:
- Urological bundling
- Wheelchair Bundling
For more information on these issues, visit the HDI Web site. As always, the latest RAC issues for each state are posted on the Revenue Cycle Institute ”Tools” Web page. Simply click the link at the top of the page to download a chart of RAC activity in your state.
CMS plans appeals town hall meeting
CMS has planned a town hall meeting for November 5 from 1-3:30 p.m. Eastern Time to discuss appeals of Medicare payment denials under Section 935 of the Medicare Modernization Act. CMS will release more information on the call in the coming weeks. Stay tuned for the latest information.
OIG issues Work Plan
On October 1, the OIG issued its Work Plan for FY 2010.
CMS rescinds, replaces LCD exception transmittal
On September 25, CMS replaced its previous transmittal on LCD exceptions. It had previously sent out the incorrect version of section 3.12. All other material remains the same.
Effective date: October 13, 2009
Implementation date: October 13, 2009
Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the author of this week’s note from the instructor.
After CMS issued Transmittal 1803, we have continued to receive questions on the correct way to bill for outpatient services when Condition Code 44 criteria have been met. The next chapter of the story involves determining if and when observation begins.
Click over to the MedicareMentor Blog to read more.
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