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Getting Familiar with State Sanction Screening Obligations (Webinar Replay)

Lee.McMillan — Thu, 26 Jan 2012 17:06:29 -0600

Click here to see a replay of the Getting Familiar with State Sanction Screening Obligations Webinar and gain a better understanding of 2012 CPT changes as we cover the following topics: Healthcare providers, as a Condition of Participation, must screen all those with whom they employ or contract with against published sanction data.

Top 5 Reasons to Attend MediRegs User Group (MUG) 2012

Lee.McMillan — Thu, 26 Jan 2012 16:28:24 -0600

When: Saturday, April 28th 2012Where: Caesars Palace, Las VegasCost: Only $99 before March 1st, 2012 ($199 after March 1st)Register Now!

ICD-10 MS-DRG Pilot Grouper Testing

Rayellen.Gilles — Mon, 23 Jan 2012 09:00:20 -0600

The PILOT MS-DRG Grouper is available now in the following MediRegs products: Compliance & Regulation Suite, Audit & Revenue Resource Center and Coding & Revenue Resource Center. On the left-hand navigation pane, under Lookup and Payment Tools, notice 2 different links; the pilot version is marked "ICD-10", and it should be understood that this logic is for testing and predicting. Use the original grouper for current year ICD-9 grouping logic.

Need a Good Fraud and Abuse Presentation?

Coding Advisory Board — Thu, 19 Jan 2012 09:17:36 -0600

Are you looking for a short, yet comprehensive, source of training material for physicians regarding Medicare and Medicaid Fraud and Abuse? Look to the OIG.

2012 CPT Changes Overview

Lee.McMillan — Fri, 02 Dec 2011 07:42:23 -0600

Click Here to view a replay of 2012 CPT Changes Overview. Viewing this webinar give you a better understanding of 2012 CPT changes, in this program we will cover the following topics:

Overview of changes in CPT for 2012
Review of each CPT change by section of CPT to include: Anesthesia, Surgery, Radiology, Pathology/Laboratory, Medicine and Category II & III codes
Rationale for change

OPPS Final Rule Review (Webinar Replay)

Lee.McMillan — Fri, 11 Nov 2011 14:39:10 -0600

Click Here to view a replay of OPPS Final Rule Review Webinar. This session will prepare hospital staff for compliance with Medicare outpatient billing guidelines in 2012 by reviewing the key provisions of the Medicare Outpatient Prospective Payment System (OPPS) Final Rule. The session will discuss and summarize 2012 Medicare payment policy and billing guideline changes for hospitals.

MediRegs' ComplyTrack Discussed in Podcast

Darci.Friedman — Thu, 10 Nov 2011 09:35:44 -0600

MediRegs' ComplyTrack modules are discussed as a model for legal technology and automation of compliance efforts in health and other industries on the November edition of Law Technology Now! Attorney Christian Liipfert, president of Houston-based Christian Liipfert Consulting, and Chicago-based Theodore L.

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Make Way For The Medicaid RACs: CMS Announces Implementation Date

Coding Advisory Board — Mon, 31 Oct 2011 14:40:10 -0500

On January 1, 2012, the Centers for Medicare & Medicaid Services (CMS) will officially implement the Medicaid recovery audit contractor (RAC) program—a very close cousin to the Medicare RAC program. Those states that haven’t already done so, and there are several that have, must hire Medicaid RACs to perform post-payment claim reviews and then identify and recover improper payments.

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How to Avoid Penalties by Understanding and Reducing Your Hospital Readmission Rates (Webinar Replay)

Lee.McMillan — Thu, 20 Oct 2011 16:16:17 -0500

Click Here to view a replay of the How to Avoid Penalties by Understanding and Reducing Your Hospital Readmission Rates webinar. The CMS readmission penalty is up to 1% of all Medicare IPPS payments in FFY 2013 climbing to 3% in 2015. Hospitals with higher readmission performance as compared to expected readmissions will face millions in lost payments.

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ICD-10 Coding Examples Webinar Registration & Replays

Rayellen.Gilles — Wed, 19 Oct 2011 12:25:04 -0500

Here is a great way to get started with ICD-10. To demonstrate how to use the ICD-10 Codebooks, MS-DRG Grouper, and ICD-10 Explorer search and mapping tool, we are holding periodic ICD-10 Examples 30 minute webinars.

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OIG to Further Investigate Entities Who Declined to Enter into CIAs

Joanna.Maher — Wed, 19 Oct 2011 11:12:02 -0500

Providers may choose to not enter into corporate integrity agreements (CIAs) after they have settled fraud cases. The OIG has decided to target these entities according to the OIG Work Plan for 2012.

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Easing the Information Security Compliance Burden for Health Care (Webinar Replay)

Lee.McMillan — Fri, 14 Oct 2011 10:42:29 -0500

Click Here to view a replay of the Easing the Information Security Compliance Burden for Health Care webinar. This webinar will cover the massive Health Care IT transformation currently underway and how this impacts health care information security compliance. Feisal will cover Health Care IT Audit / Compliance requirements, security and mapping security to various compliance requirements. Review the compelling needs for using a framework to manage the process and a strategy for executing within the framework.

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Sanction Screening Rules, Requirements and Techniques

Lee.McMillan — Wed, 28 Sep 2011 11:22:56 -0500

Click Here to view a replay of the "Sanction Screening Rules, Requirements and Techniques" Webinar!

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Surviving and Thriving in the Age of Healthcare Audit Accountability (Webinar Replay)

Lee.McMillan — Fri, 23 Sep 2011 11:37:02 -0500

Click Here to view a replay of the "Surviving and Thriving in the Age of Healthcare Audit Accountability" Webinar!

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Conflicting Diagnoses – When to Query and When Not To ...

Coding Advisory Board — Wed, 14 Sep 2011 10:18:54 -0500

With ICD-10 just around the corner, many facilities are in the process of reviewing their physician documentation and their coding and querying processes in the Health Information Management (HIM) department and Clinical Documentation Improvement Programs (CDIP). These reviews are being performed to determine – will my documentation be sufficient for ICD-10 coding requirements. Do my coding processes result in compliant and optimal claims?

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Final Changes to ICD-9-CM Code Set for 2012

Coding Advisory Board — Wed, 14 Sep 2011 10:10:23 -0500

The last major revision to ICD-9-CM has been made, and the updated codes are available on the CMS website here: https://www.cms.gov/ICD9ProviderDiagnosticCodes/07_summarytables.asp#Top... The updated list includes diagnosis and procedure codes.

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ICD-10-PCS 2012 Update Available on CMS Website

Coding Advisory Board — Wed, 14 Sep 2011 10:04:45 -0500

The 2012 ICD-10-PCS Update is available for download on the CMS website at:http://www.cms.gov/ICD10/11b15_2012_ICD10PCS.asp#TopOfPage. In addition to the Index and Table file, the 2012 Guidelines are also posted.  This is the last full update that will be published prior to the implementation date of October 1, 2013.

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2012 Brings an Exciting New Set of Procedures Codes

Coding Advisory Board — Wed, 14 Sep 2011 09:57:42 -0500

You would almost think that after all these years there really couldn’t be many additional CPT procedure code set updates. The 2012 codes, however, have been released and we do find another year with new codes, definition changes and deleted codes. Some changes are of course more dramatic than others. For example, there are a lot of new laboratory codes for genetic testing, which is not surprising given that this an emerging area in medicine. Next to lab I think the areas with the greatest number of changes for 2012 are cardiology and pain management.

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Drugs of Abuse: Qualitative Testing (Webinar Replay)

Lee.McMillan — Thu, 08 Sep 2011 18:33:11 -0500

Click Here to view a replay of the "Drugs of Abuse: Qualitative Testing - What has the industry learned?" Webinar! This presentation will cover understanding the laboratory issues noted by the OIG. Attendees will learn which qualitative drug testing is at risk and what steps to take to mitigate the risk by:

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Meaningful Use - A Roadmap from Risk Assessment to Remediation (Webinar Replay)

Lee.McMillan — Fri, 26 Aug 2011 11:37:47 -0500

Click Here to view a replay of the Webinar! Meaningful Use, HIPAA, State regulations and many other standards require a risk assessment as part of compliance. But what comes after the risk assessment? How do organizations take what they have learned about their environment and risks and turn that into an actionable and appropriate plan for remediation?

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Understanding CMS Medicare Manuals, Transmittals & MLN Matters

Rayellen.Gilles — Wed, 27 Jul 2011 08:28:55 -0500

Because the CMS Manuals are so critical to compliance, coding, reimbursement, and audit, it is important to understand what is going on with the manual format, transmittals links and changes. I hope this mini-tutorial helps.

CMS Publications

Medicare makes available on its website 2 publications: 1 - Transmittals, which are CHANGES to the Pub 100 "Internet Only" Manuals, or IOMs.2 - Copies of the CURRENT versions of the manual, broken down by Chapter, in PDF format.

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Meaningful Use and Your Compliance Program (Webinar Replay)

Lee.McMillan — Tue, 19 Jul 2011 17:27:06 -0500

Click Here to view a replay of the Webinar! Compliance Officers are active participants in their organization's efforts to achieve Meaningful Use and meet the CMS goals to improve quality, engage patients and families, improve care coordination, improve public health, and ensure adequate privacy and security protections for personal health information.

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Developing a Personalized Learning Plan For ICD-10-PCS (Webinar Replay)

Lee.McMillan — Tue, 21 Jun 2011 21:44:38 -0500

Click Here to view a replay of the Webinar! Successful coding in ICD-10-PCS is dependent upon solid anatomy knowledge. This program will cover the basics of the ICD-10-PCS coding system and describe how anatomy knowledge can improve your speed, accuracy and understanding in the new system. We’ll discuss how to develop a personalized learning plan for ICD-10-PCS and cover some of the most helpful resources available for coders. We’ll also demonstrate the MediRegs Coding Suite tools for ICD-10-PCS.

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ICD-10 Coder Productivity

Rayellen.Gilles — Thu, 26 May 2011 12:44:44 -0500

It has been widely predicted that there will be a significant drop in coder productivity when ICD-10 coding begins. In a recent Vantage Point survey, (See the results presented by HIMSS here), nearly half the respondence noted that their greatest concern related to ICD-10 is a revenue loss due to a bottle neck of coding issues. Here is how we can help!

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Clinical Documentation Improvement (Webinar Replay)

Lee.McMillan — Wed, 18 May 2011 16:30:37 -0500

What Does ICD-10, Regulatory Audits, and Quality Indicators Have in Common With Your Clinical Document Improvement Program

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ICD-10 examples to try in the new ICD-10 Explorer

Rayellen.Gilles — Thu, 12 May 2011 09:36:02 -0500

Compliance & Regulation Suite and Coding Suite users now have access to the ICD-10 Explorer tool. Go the the Codebooks library and scroll down.

You have probably heard a lot about the enormous differences in the clinical terminology, increased specificity, and complexity of the I-10 generally equivalent maps. The ICD-10 Explorer tool is an excellent way to explore these instantly. Try the following examples to begin your understanding of the capabilities of this tool.

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Bookmark This: Health IT Buzz Blog!

Darci.Friedman — Wed, 27 Apr 2011 08:44:44 -0500

As many of you know, ONC is emerging as the player agency in things health IT. ONC (and sometimes you see ONCHIT) stands for the Office of the National Coordinator for Health Information Technology. ONC is the principal Federal entity charged with coordination of nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information.

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(Webinar Replay) Implementation Best Practices: The "How to" as you transition to ICD-10

Lee.McMillan — Tue, 26 Apr 2011 16:00:59 -0500

Want to review?

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Proposed Changes to ICD-9-CM Procedure Codes

admin — Wed, 20 Apr 2011 15:08:58 -0500

The ICD-9 Coordination and Maintenance Committee convened in Baltimore on March 9-10 to consider proposed changes to ICD-9-CM Procedure Codes for 2012. The outcome of this meeting includes the Committee to implement a partial freeze of the ICD-9-CM and ICD-10 codes prior to the implementation of ICD-10 on October 1, 2013. The partial freeze will be implemented as follows:

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Trying to learn about ICD-10

admin — Wed, 20 Apr 2011 14:39:38 -0500

Have you heard people say that all coders need to take an anatomy and physiology course to be able to code in ICD-10-CM or PCS? Think twice before signing up for a full college course or even buying the thickest anatomy book you can find. Try using the personal improvement approach instead.

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The Scoop on 2011 Hospital OPPS Billing

Coding Advisory Board — Mon, 18 Apr 2011 13:31:42 -0500

Hospital managers trying to catch up on all of the changes made in the 2011 update of the hospital outpatient prospective payment system (OPPS) will be glad to know about three new transmittals issued by the Centers for Medicare & Medicaid Services (CMS). The following transmittals include continuing policies as well as new 2011 policies.

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Code Explorer lets you see Outpatient and Physician Payment Rules on One Screen

Rayellen.Gilles — Wed, 13 Apr 2011 10:48:02 -0500

I'm writing an article to discuss the power of key word searching to find codes, rather than looking in a book or trusting a code-range search, and the Mammography codes are a great example. The key word search in our Code Explorer tool for the term mammogra* finds all Mammogram and Mammography codes. Scrolling down makes it easy to see which codes are used for measurement reporting, which codes are payable, and you can even see the payment rate, adjusted to your locality or provider!

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(Webinar Replay) Understanding Exclusions and the Need to Undertake Regular Sanction Screening

Lee.McMillan — Thu, 24 Mar 2011 16:01:30 -0500

Click View Recording to see a replay of the "Understanding Exclusions and the Need to Undertake Regular Sanction Screening" Webinar

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Searching across all MAC LCDs on MediRegs

Rayellen.Gilles — Mon, 21 Mar 2011 10:20:49 -0500

A number of smart LCD/MAC Policy users have asked for an easy way to tailor the product to automatically search just one state/data set for each payer, or to recieve weekly alerts for their favorite payer(s) about new policies. This article contains simple instructions to make the LCDs work for you.

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(Webinar Reply) "Incident To" Who, What, When and How Can I Bill For Non-Physician Providers

Lee.McMillan — Tue, 08 Mar 2011 16:37:14 -0600

Click View Recording to see a replay of the "Incident To" Who, What, When and How Can I Bill For Non-Physician Providers Webinar

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E/M Codes Continue as Focus on OIG Workplan FY 2011

Coding Advisory Board — Mon, 28 Feb 2011 10:57:27 -0600

The FY 2011 Office of the Inspector General Work Plan contains two issues that professional fee coders should be concerned about. Correct coding of E/M services based on the guidelines and E/M services during global surgery periods are ongoing issues.

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New Preventive Services Modifier 33

Coding Advisory Board — Mon, 28 Feb 2011 10:22:34 -0600

There is a new modifier in town, and its number is 33. Because of the Patient Protection and Affordable Care Act (PPACA), there is now a requirement for health insurance plans to cover preventive services without any cost sharing (meaning no copays, coinsurance or deductibles applying).

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Diagnostic Radiology Rules & Reimbursement

Coding Advisory Board — Mon, 28 Feb 2011 10:12:19 -0600

Diagnostic radiology rules and reimbursements change every year and 2011 is no exception. I would argue that there has never been a more stressful time than today. Most recently Aetna announced a new discounting policy for imaging services that will cut payments to many providers. In the December 2010 issue of Aetna OfficeLink Updates™, the payor stated that it will begin reducing payments when multiple CT, M

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RAC Audits -- An Overview

Coding Advisory Board — Mon, 28 Feb 2011 08:48:54 -0600

In order for the Centers for Medicare and Medicaid Services (CMS) to combat fraud and abuse, one of the provisions of the Tax Relief and Healthcare Act of 2006 gave CMS the authority to engage with private contractors to create the Recovery Audit Contractor (RAC) program. These RACs review previously paid claims to ensure that the claims were paid consistent with CMS’ manuals, NCDs, and LCDs. They also refer to prior audits performed by the OIG, CERTs, and use internal data mining utilizing their own proprietary software programs.

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First Civil Monetary Penalty Administered by HHS for Violation of the HIPAA Privacy Rule

Joanna.Maher — Wed, 23 Feb 2011 16:16:07 -0600

Cignet Health (Cignet) has become the first covered entity to be issued a civil monetary penalty. The HHS Office of Civil Rights (OCR) has imposed a penalty of $4.3 million. The violations were a result of the new rules and regulations set forth in Section 13410(d) of the HITECH Act.

For further details see links below.

http://www.hhs.gov/ocr/privacy/hipaa/news/cignetnews.html

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Agenda Update: 2011 MediRegs User Group Event

Jenna.Wojciechowski — Tue, 15 Feb 2011 09:58:48 -0600

The agenda for the 2011 MediRegs User Group Event has been announced! Based on your feedback, the agenda includes 2011 ComplyTrack Releases, various panel discussions, and breakout sessions by facility type and module.

View the full agenda and registration information here: http://goo.gl/f6BjX

Register by March 15 and take advantage of special pricing!

The Compliance & Regulation Suite has arrived!

Lauren.vanderKeyl — Tue, 08 Feb 2011 09:14:25 -0600

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(Webinar Replay) Clinical Trials: How to Stay Medicare Compliant

Lee.McMillan — Mon, 07 Feb 2011 14:25:54 -0600

Click View Recording to see a replay of the Clinical Trials: How to Stay Medicare Compliant Webinar

Clinical trial billing can be complex and organizations involved in clinical trials can be exposed to compliance risks if not done correctly. This presentation outlines key components of clinical trial billing as well as understand Medicare coverage guidelines and how to remain compliant with the Medicare program.

Participants will learn:

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Red Flag Program Clarification Act

Joanna.Maher — Fri, 04 Feb 2011 15:06:25 -0600

On December 18, 2010, President Obama signed into law the Red Flag Program Clarification Act. The new law limits the circumstances in which creditors are covered by the Red Flags Rule. The FTC is revising the materials on their site to reflect the change in the law.

See the new law here:

http://www.gpo.gov/fdsys/pkg/BILLS-111s3987enr/pdf/BILLS-111s3987enr.pdf

Really?!? The OIG Issues Top Ten Most Wanted List!

Darci.Friedman — Thu, 03 Feb 2011 10:16:15 -0600

Wow! The OIG has just launched its "Most Wanted Fugitives List". Yes, you read that right. The OIG now has a website where they have posted a list, complete with photos and profiles, of their most wanted individuals sought on charges of health care fraud and abuse. The OIG is asking for the public’s help in tracking down the fugitives as the public has a stake in the fight against fraud, waste, and abuse.

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2011 Hospital Outpatient Updates

Rayellen.Gilles — Thu, 20 Jan 2011 05:30:57 -0600

This year, we recieved numerous inquiries regarding the delay in posting Hospital Outpatient PPS Information in the Codebooks and the APC Grouper & Calculator.  The purpose of this article is to explain how we update these tools, to highlight a common occurance of major differences between versions of the OPPS Addendum files posted by CMS, and to provide a summary of the specific changes detected this year. Please go to the APC CodeBook Download Center on the product for a detailed repor

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Registration for the Medicare EHR Incentive Program Has Begun!

Darci.Friedman — Wed, 05 Jan 2011 09:21:39 -0600

As you know, the Medicare EHR Incentive Program will provide incentive payments to eligible professionals, eligible hospitals, and CAHs that demonstrate "meaningful use" of certified EHR technology. Registration for the program began on January 3, 2011.

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Vaccine Administration Changes are a Sticky Business for 2011

Coding Advisory Board — Thu, 30 Dec 2010 10:35:49 -0600

The vaccine administration codes are changing in CPT 2011 and the new series of codes is no longer assigned based on the number of “sticks” the patient receives.

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New ACA’S Wellness Visit (PPPS): Coverage Doesn’t Mean Clarity

Coding Advisory Board — Thu, 30 Dec 2010 10:28:41 -0600

Certainly the implementation of an annual wellness visit for Medicare beneficiaries is a step in the right direction; however,it does not necessarily solve the problem of problems encountered during the visit. I bring this up as most of my primary care clients will agree that it’s a rare occasion where a Medicare beneficiary is scheduling for a true “preventative visit”. Typically, this is a visit to follow-up on old problems and most commonly a host of new issues. Under the PPPS requirements, the annual wellness visit includes at a minimum the fol

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2011 CPT Changes Overview (Webinar Replay)

Lee.McMillan — Fri, 17 Dec 2010 10:59:13 -0600

Click View Recording to see a replay of the 2011 CPT Changes Overview webinar.

Gina L. Hobert, Billing Compliance Manager from MaineHealth Audit and Compliance reviews the 2011 CPT changes, on this program we will cover the following topics:

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Integrating the OIG Work Plan into your Risk Assessment and Mitigation Process (Webinar Replay)

Lee.McMillan — Thu, 16 Dec 2010 08:50:08 -0600

John Wallace, Chief Compliance Officer Rutland Regional Medical Center discusses his experiences with implementing a risk assessment and mitigation process through several cycles of improvement and how leveraging workflow solutions have improved the process.

Click View Recording to see a replay of the Integrating the OIG Work Plan into your Risk Assessment and Mitigation Process Webinar.

In this program he’ll focus on:

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Analysis of Consultation CPT Code Changes Effective 01/01/2010

Coding Advisory Board — Mon, 15 Nov 2010 11:53:14 -0600

Effective January 1, 2010, the Centers for Medicare & Medicaid Services (CMS) began no longer paying for CPT consultation codes (inpatient and office/outpatient codes) except for telehealth consultation HCPCS G-codes. Providers should now report visits that would have been billed under CPT consultation codes, with an E/M code based on where the visit occurs and the complexity of the visit performed. This change in policy applies only to providers billing Medicare under the fee-for-service program.

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New Subsequent Observation CPT Codes

Coding Advisory Board — Mon, 15 Nov 2010 08:54:11 -0600

The new CPT codes for 2011 have been released and include new subsequent observation codes for physicians who perform hospital services. Three new codes are being introduced for subsequent observation care per day. While observation codes have previously had a code that captured admission and discharge services, coders were often instructed to use office visit codes or an unlisted code to capture other observation care services for subsequent day care.

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2011 HCPCS Codeset is ready

Rayellen.Gilles — Mon, 08 Nov 2010 06:51:49 -0600

November Update: HCPCS and BETOS updates have been included in the HCPCS & CPT Pre-release Codebook! Check daily e-mail updates for the changes report, the download center for a much easier to use HCPCS data file than the one CMS publishes, and the bottom of the codebook for a series of very helpful index files. Read the entire blog update here: http://www.mediregs.com/blog/2010/09/procedure-codes-2011-update.htm

CT RAM Work Plan Question Sets for Hospitals Now Available!

Darci.Friedman — Wed, 03 Nov 2010 12:11:31 -0500

We are pleased to announce that the question sets for the 2011 OIG Work Plan for Hospitals are now available!

The new question sets are:

Non-IPPS Hospital Payments for Nonphysician Outpatient Services

Medicare Excessive Payments

Hospital Occupational Mix Data Used to Calculate Inpatient Hospital Wage Indexes

Early Implementation of Medicare’s Policy for Hospital-Acquired Conditions

Hospital Reporting for Adverse Events

Hospital Reporting for Restraint and Seclusion Related Deaths

Medicare Brachytherapy Reimbursement

Hospitals Compliance With Medicare CoP Intensity-Modulated and Image-Guided Radiation Therapy Services

Medicare Inpatient and Outpatient Hospital Claims for Replacement of Medical Device

Hospital Inpatient Outlier Payments

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Time Based CPT Services and New RAC Issues for Physicians Services – Webinar Replay!

Lee.McMillan — Fri, 29 Oct 2010 15:07:21 -0500

If you missed the webinar on Thursday, Oct 28, 2010, click View Recording to see a replay of the Time Based CPT Services and New RAC Issues for Physicians Services webinar.

By listening to this webinar you will have a better understanding of time based CPT codes and RAC issues for physician services, including:

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Save the Date: MediRegs User Group 2011

Lauren.vanderKeyl — Mon, 25 Oct 2010 09:10:11 -0500

The MediRegs User Group for 2011 has been announced, join us!

When: Saturday, April 9th 2011 Where: Disney Swan Dolphin – Orlando, FL Cost: Only $125 per person

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Proposed 2011 PQRI Changes -- Are you Ready?

Coding Advisory Board — Mon, 18 Oct 2010 15:11:46 -0500

The Centers for Medicare and Medicaid Services (CMS) proposed changes to the Physician Quality Reporting Initiative (PQRI) program that could make participation in the program more enticing. Of course financial incentives play a big role in fostering participation in any program. One provision of the Affordable Care Act (ACA) extended the payments issued through PQRI program until 2014; however the amount

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Research for Coding Edits

Rayellen.Gilles — Mon, 18 Oct 2010 08:11:07 -0500

A smart customer asks: "We are researching policies to support our editing and to create new edits Nationally as well as regionally/locally. We also support Medicaid in quite a number of states and need to be able to research each state’s policies.... How can the Coding Suite help?" GREAT Question!

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How to Succeed as a Compliance Professional – Webinar Replay!

Lee.McMillan — Fri, 08 Oct 2010 10:36:44 -0500

If you missed webinar on Tuesday October 5th, 2001, click View Recording to see a replay of the How to Succeed as a Compliance Professional Webinar.

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OIG Releases 2011 Work Plan

Darci.Friedman — Mon, 04 Oct 2010 08:03:17 -0500

For all of you out there who were waiting with baited breath (oh, wait, that was just me)...the Office of the Inspector General released the 2011 Work Plan. But, I have noticed a couple of things right off the bat and wanted to share. First, it is longer than last year! This may not mean a lot, but for those of us who sit and read the whole document, it is significant. Last year it was 128 pages, this year it is 159 -- 31 more pages. Sigh. Second, in addition to being able to download the entire .pdf, the OIG has also provided .pdf's to the individual Wor

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Procedure Code Effective Dates, Deleted Code Replacement Codes.

Rayellen.Gilles — Wed, 29 Sep 2010 15:42:32 -0500

Where do I find the effective date of a procedure code?

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Proposed Signature Requirements for Laboratory Requisition

Coding Advisory Board — Wed, 29 Sep 2010 14:18:40 -0500

The clinical laboratory as a billing provider of diagnostic services is caught in the middle between two entities - the ordering physician / practitioner and the payer – when attempting to maintain compliant documentation for billed services. By referencing the Part B CERT Reminder issued by WPS on January 25, 2010, it is clear that not all payers truly understand the distinction between a requisition submitted to the laboratory and the physician order.

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Medical Necessity Criteria for Radiopharmaceutical Agent Reimbursement

Coding Advisory Board — Wed, 29 Sep 2010 14:08:06 -0500

On August 28, 2010, Wisconsin Physicians Service Insurance Corporation (WPS), FI 52280, published Radiopharmaceutical Agents #RAD-026 V2 Approved DRAFT LCD. This draft LCD is one of the first, if not the first LCD, that establishes medical necessity criteria by specific CPT code procedure(s) for radiopharmaceutical agent reimbursement. The draft LCD Indications and Limitations of Coverage and/or Medical Necessity section indicates that radiopharmaceuticals will be considered medically necessary when used with the procedures listed in Table 1 of this draft LCD.

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Procedure Codes for 2011 Update

Rayellen.Gilles — Wed, 22 Sep 2010 13:47:21 -0500

November Update: HCPCS and BETOS updates have been included in the HCPCS & CPT Pre-release Codebook! Check daily e-mail updates for the changes report, the download center for a much easier to use HCPCS data file than the one CMS publishes, and the bottom of the codebook for a series of very helpful index files.

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Revenue Codes and Crosswalks

Rayellen.Gilles — Fri, 17 Sep 2010 07:37:35 -0500

Where are the Revenue Codes in MediRegs? Good question!

Go to the HCPCS & CPT(R) CodeBook to find a chapter with revenue codes and a nice index. There you will find the official definition of each revenue code, as well as links to related Claims Processing manual information. That helps to define and clarify use of revenue codes, but the most common question is about Revenue Code to Procedure Code crosswalking. Unfortunately, CMS has not issued an official crosswalk, so we rely on 2 sources to glean appropriate mapping.

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State Regulatory Research Example

Rayellen.Gilles — Wed, 15 Sep 2010 10:03:25 -0500

Searching across multiple states for related information is easy on MediRegs, but there are some challenges because states vary the language they use for similar issues, and even whether they dicate a standard via legislative, regulatory or Medicaid publications. Each of the Medicaid Manuals has a STATE CHART which is a great way to compare apples-to-apples language for things like eligiblity requirements and how the Medicaid program is set up. The following how-to article is designed to help you understand the best way to search across multiple states.

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Figuring out how much you get paid

Rayellen.Gilles — Fri, 10 Sep 2010 06:52:18 -0500

We offer free training to all customers, and the first "Basic" training shows you how to use the system; additional classes cover coding, reimbursement and advanced research techniques. Frequently, new users on the system want to know "Where do I find the fee schedules?" or "How can I tell what Medicare will reimburse them for a particular procedure, test?" or &qu

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Physician Quality Reporting Initiative (PQRI) – Screening for Unhealthy Alcohol Use

Coding Advisory Board — Tue, 31 Aug 2010 10:13:15 -0500

In 2009, the Centers for Medicare and Medicaid Services (CMS) added a new PQRI measure titled Preventive Care and Screening: Unhealthy Alcohol Use – Screening. It was developed by the Physician Consortium for Performance Improvement. The criterion for the measure requires providers to assess a patient’s use of alcohol using a systematic method of screening on an annual basis.

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Resources to investigate RAC MS-DRG Validation and Medical Necessity Review

Rayellen.Gilles — Wed, 25 Aug 2010 12:38:09 -0500

Are you struggling to research coding, payment, medical necessity and compliance rules related to the myriad reviews and issues from your Recovery Audit Contractor (RAC) or other investigators? This article is designed to show you how to get to the most often-requested information as it relates to MS-DRG Validation and Medical Necessity Reviews. Instructions apply to the Regulation & Reimbursement Suite or Audit & Revenue Resource Center unless otherwise noted.

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2011 ICD-9-CM, MS-DRG and Inpatient PPS Regulatory Updates

Rayellen.Gilles — Wed, 25 Aug 2010 12:14:43 -0500

FY 2011 (10/01/2010) is coming up fast, and we've got you covered on the Regulation & Reimbursement Suite and Coding Suite.  The Inpatient Final Rule in E-Book format is ready to use, and the 2011 ICD-9-CM and 2011 MS-DRG Pre-released codebooks are available. Also, you can get a head start on understanding ICD-10-CM and ICD-10-PCS with a comprehensive book available now. Watch your daily e-mail alert, or visit the Inpatient, Coding, or Coding Guidance libraries for access to these resources.

What is a Regulatory E-BOOK?

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Four Major Insurers Announce Meaningful Use Incentives

Darci.Friedman — Wed, 18 Aug 2010 07:51:27 -0500

On August 5, 2010, four major insurers announced meaningful use incentives. Aetna, Highmark, UnitedHealth Group and WellPoint, at minimum, will align their pay-for-performance programs with federal meaningful use criteria. In a joint statement, National Coordinator for Health Information Technology David Blumenthal, M.D., and Centers for Medicare and Medicaid Services' Principal Deputy Administrator Marilyn Tavenner, stated:

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Benchmarking E/M Services

Coding Advisory Board — Fri, 13 Aug 2010 11:20:21 -0500

Having trouble using the most recent Part B Utilization data file from CMS? You’re not alone. Lots of people are upset about the non-friendly .pdf version of the file this year. The gurus at Wolters-Kluwer heard your concerns and converted the file to the Excel format for easier use.

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Facility Evaluation & Management and the 2011 OPPS Proposed Rule

Coding Advisory Board — Fri, 13 Aug 2010 11:13:38 -0500

Hospitals have been struggling since the inception of the Outpatient Prospective Payment System (OPPS) back in 2000 with CMS’s instructions for hospitals to develop internal hospital guidelines to determine what level of visit to report for each patient. General guidelines have been provided over the course of the last 10 years such as:

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Medicare Part B Coverage of Preventive Exams - New Rules for 2011

Coding Advisory Board — Fri, 13 Aug 2010 10:45:13 -0500

As part of the Patient Protection and Affordable Care Act, Medicare Part B coverage for preventive exams will change. Starting on January 1, 2011, Medicare will cover an annual preventive examination. The Initial Preventive Physical Examination service will remain and be available as a service those beneficiaries within the first 12 months of coverage under Part B. The coinsurance/deductible will not apply to the new preventive services.

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Watch the RAC Websites for Medical Necessity Issues...

Darci.Friedman — Wed, 11 Aug 2010 08:10:58 -0500

The AHA reports that CMS' New Issue Review Board approved the first "medical necessity review" audits last week. The audits include eighteen types of inpatient hospital claims and one type of DME claim. Remember that the RAC's must post the issues on their websites before issuing Additional Documentation Requests. CMS expects the RACs to post the new audits and begin issuing ADR's within the next two weeks. So, watch the RAC websites. For your convenience, the issue pages on the RAC websites are:

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Don't Lose Out on the EHR Incentive Dollars: Enrollment in PECOS Required!

Coding Advisory Board — Mon, 26 Jul 2010 09:14:04 -0500

The Medicare Electronic Health Record (EHR) Incentive Program is only available to “eligible” professionals and hospitals. The final rule will soon be published and CMS is planning to use the Provider Enrollment, Chain and Ownership System (PECOS) to verify Medicare enrollment. While this may seem like a no-brainer, you may or may not have an enrollment record in PECOS. Use the checklist below to avoid a last minute scramble that could impact your incentive payment.

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ComplyTrack Risk Assessment Questions Updated!

Darci.Friedman — Wed, 07 Jul 2010 07:49:11 -0500

Summary of Changes to Questions Sets - Second Quarter 2010

We would like to notify you of changes that have been made to the ComplyTrack Risk Assessment questions in the Comprehensive Library for the Provider Baseline. As part of the Quarterly Review Process, the following Risk Assessments were reviewed this quarter:

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OPR Coverage – Is this What we Expected?

Coding Advisory Board — Fri, 02 Jul 2010 10:57:58 -0500

On May 7, Medicare finally released the transmittals which summarize the basic rules for documentation, coding and billing of outpatient pulmonary rehabilitation (OPR) services. Multiple updates to the Medicare manuals were provided via two CMS transmittals – 124 (CR 6823) and 1966 (CR 6823) which describe the national coverage guidelines for OPR.

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Medical Decision Making – Breaking It Down. Part 1 of 3: Number of Diagnosis & Management Options

Coding Advisory Board — Fri, 02 Jul 2010 10:43:03 -0500

Medical Decision Making (MDM) is one of the three “key components” of determining the level of an evaluation and management (E/M) service. It is probably the most difficult component of an E/M service to review. MDM is where the providers thought process is quantified and most often the primary role in determining the correct level of service or E/M code.

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Category III Codes Available for Facet Joint Injections Using Ultrasound Guidance

Coding Advisory Board — Fri, 02 Jul 2010 10:30:33 -0500

In CPT 2010, the AMA implemented new codes for facet joint injections. The CPT editorial panel clarified that facet joint injections require the use of imaging guidance and included the guidance in the code description. The new codes of 64490 to 64492 for cervical or thoracic facet joints and 64493 to 64495 for lumbar or sacral facet joint injections include fluoroscopy or CT guidance. They also clarified that if imaging is not used, codes 20550 to 20553 are to be used for these injections.

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Billing for Drug Waste: A Look at the New Modifier – JW

Coding Advisory Board — Fri, 02 Jul 2010 10:24:55 -0500

The reporting of new modifier –JW, which specifies the portion of a single dose vial (SDV) or single use package that was not administered to the patient, and which goes into effect July 30, 2010, is optional at this time.

Medicare guidelines state to report the drug amount administered on one line, and on a separate line you may report the amount of drug NOT administered (wasted) with modifier –JW appended to the associated HCPCS code.

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Pub. 100-22? CMS Issues a New Manual

Darci.Friedman — Fri, 11 Jun 2010 15:44:28 -0500

On June 11, 2010, CMS issued a transmittal containing the first two chapters of a new Manual. The Manual is Pub. 100-22 and is titled "Medicare Quality Reporting Incentive Programs". The Manual addresses the Physician Quality Reporting Initiative (PQRI) and E-Prescribing (eRx) Medicare Quality Reporting Incentive Programs.  The Manual does not establish new requirements for the PQRI and eRx programs. It simply manualizes existing requirements to the programs.

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FTC Red Flags Enforcement Delayed Again

Lauren.vanderKeyl — Mon, 07 Jun 2010 11:13:41 -0500

In accordance with a request from Congress, the FTC has delayed enforcement of the Red Flags Rule until December 31, 2010. This enforcement extension is necessary in order for lawmakers to finalize the scope of those impacted by the Rule. Should legislation determining the scope of affected entities be passed before the new deadline, the Rules will go into immediate effect.

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Understanding Complex Physician Fee Schedule Changes in 2010

Rayellen.Gilles — Sat, 05 Jun 2010 08:43:30 -0500

The Physician Fee schedule has had numerous and confusing updates this year, so I thought a quick note to customers about how we can help would be in order. Key issues include:

The January 2010 RVU file had multiple updates and corrections.

The April 2010 RVU file was not published by CMS.

The Affordable Care Act created RETROACTIVE payment changes to the some RVUs and the conversion factor back to 01/01/2010.

The payment rates for July 2010 are still in flux.

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New Advance Beneficiary Notice Modifiers Effective April 2010

Coding Advisory Board — Fri, 21 May 2010 14:00:23 -0500

On April 5, 2010, CMS revised the Advance Beneficiary Notice of Noncoverage (ABN) modifiers. The purpose of the new modifiers is to differentiate between voluntary and mandatory use of the liability notice.

The new modifiers are:

-GA –Waiver of Liability Statement Issued as Required by Payer Policy

-GX – Notice of Liability Issued, Voluntary under Payer Policy

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Self-Administration of Drugs or Biologicals and Recovery Audit Contractors (RAC)

Coding Advisory Board — Wed, 19 May 2010 16:31:12 -0500

CMS recently released Transmittal 123 (Change Request 6950) on April 30, 2010 on Determining Self-Administration of Drugs or Biologicals which took effect on April 30, 2010. Transmittal 123 provided contractors with updates to manual language related to the determination of self-administration of drugs and biologicals, to allow for other routes of administration besides injections to be considered as not usually self-administered based on some new drugs that were approved by the Food and Drug Administration.

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CMS Issues Clarification on PR (Pulmonary Rehabilitation) Guidelines

Coding Advisory Board — Wed, 19 May 2010 11:46:13 -0500

As part of the initial implementation of the PR program January 1, 2010, CMS recently issued Transmittal 124 (May 7^th 2010) within the Medicare Benefit Policy Manual clarifying medical necessity along with program specifications and supervision requirements. As many of the new preventative services offered by CMS, the goal of the program is patient awareness and education to facilitate more aggressive self care.

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Summary of April IOCE Changes

Coding Advisory Board — Wed, 19 May 2010 11:04:50 -0500

The Integrated Outpatient Code Editor Summary of Data Changes document, published quarterly by CMS, is exceedingly valuable for hospital chargemaster maintenance. It is concise and lists all coding changes by their effective date. It is an essential for quarterly chargemaster updates.

The IOCE Summary of Data Changes document provides all quarterly changes related to:

APC CHANGES

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HCPCS "S" Codes: What are they?

Coding Advisory Board — Wed, 19 May 2010 09:46:15 -0500

I recently completed a consulting project for a client that required researching commercial payer coverage policies for a specific procedure. What I found was that, in addition to a list of relevant CPT codes for the particular service I was researching, there was a host of HCPCS “S” codes that were included in some of the coverage policies. It occurred to me that these are not codes you come across every day, so I took the opportunity to refresh my understanding of these codes. I’ll share with you what I learned.

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Inpatient Rule Making for 2011 Begins - EBook Available

Rayellen.Gilles — Wed, 12 May 2010 14:30:11 -0500

CMS published the 2011 Inpatient Prospective Payment System Proposed Rule on May 4, 2010. This year's proposals include changes to the MS-DRG payment rates for 2011, clarification on provider aggreements and supplier approvals, new COPs (Hospital Conditions of Participation) for Rehabilitation and Respiratory care services, and accreditation requirements for Inpatient Psychiatric services for individuals under the Age of 21.

This year's rule is 472 pages, with additional data and files not included in the rule (published instead on the CMS website).

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Key RAC Resources

Coding Advisory Board — Mon, 10 May 2010 08:27:48 -0500

Have you noticed one of the newest features in the MediRegs Coding Suite of products? Under Special Searches on the right hand side tool bar is now a direct link to RAC Issues. Key RAC Resources may be found here, including a direct link to CMS’s RAC information, Region A and B’s index of issues (Mediregs is attempting to secure permission from Regions C and D to post the issues listed on their respective websites), and a summary of RAC issues.

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Changes in Provider and Supplier Enrollment, Ordering and Referring, and Documentation Requirements

Darci.Friedman — Thu, 06 May 2010 08:19:06 -0500

On May 5, 2010, CMS issued an interim final rule implementing provisions of the Patient Protection and Affordable Care Act (PPACA). The rule implements the provision which requires all providers of medical or other items or services and suppliers that qualify for a National Provider Identifier (NPI) to include their NPI on all applications to enroll in the Medicare and Medicaid programs and on all claims for payment submitted under the programs.

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ICD-10: Leading the way......

Maria.Bounos — Thu, 15 Apr 2010 16:02:21 -0500

Questions, questions, some answers, but more questions as I reflect on the 2010 ICD-10 AHIMA Summit that I attended earlier this week. One of the big questions is are YOU ready for this big change in healthcare and have you started to PREPARE? ICD-10 will affect all aspects in healthcare (payers, providers, vendors, clearinghouses, third party administrators, independent laboratories, employers, and researchers) to name a few.

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Raising Ethical Issues

Darci.Friedman — Fri, 09 Apr 2010 08:30:15 -0500

The March issue of the Harvard Business Review contains an article by Mary Gentile called Keeping Your Colleagues Honest.  HBR adapted from that article to provide one of its recent Management Tips of the Day.  For those of us in compliance, we are often forced to raise and confront others on ethical issues. This can be challenging!  Read through these tips and think about how you presently handle these situations. Can you do it better? These tips may help make any future discussions you have just a little less painful.

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Announcing....www.cms.gov

Darci.Friedman — Wed, 07 Apr 2010 08:29:28 -0500

Blink and you might have missed it! On Monday, April 5, 2010, CMS changed its website address from www.cms.hhs.gov to

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Announcing an easier way to understand RAC Issues

Rayellen.Gilles — Tue, 06 Apr 2010 13:25:46 -0500

To assist customers with understanding issues being investigated by the Recovery Audit Contractor, MediRegs has launched a new set of resources.

RAC Issues Comparison Chart

On the left-hand navigation pane of the Coding & Revenue Resource Center, the Audit & Revenue Resource Center, and the Regulation & Reimbursement Suite, you will find a new RAC ISSSUES link. This sortable table outlines the types of issues being investigated by the 4 Recovery Audit Contractors.

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More on Physician Supervision in the Hospital Outpatient Setting

Coding Advisory Board — Mon, 05 Apr 2010 15:53:37 -0500

Just when you think you have Physician Supervision in the Hospital Patient Setting figured out, revised terminology in Medicare rules raise new questions.

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Illegible Signatures Targeted by Carriers

Coding Advisory Board — Mon, 05 Apr 2010 15:46:58 -0500

CMS is once again deeming claims as “insufficient documentation” if the provider’s signature is missing or illegible as part of a post-payment review. According to the Medicare Program Integrity Manual (Pub 100-8) Ch. 3, Sec.

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Some Clarification Given when Billing Consultation Codes

Coding Advisory Board — Mon, 05 Apr 2010 15:37:10 -0500

It has been a few months since Medicare officially announced they would no longer allow payment for the inpatient (99251-99255) or outpatient (99241-99245) consultation codes. The works RVUs for the consultation codes have been distributed to increase the work RVUs for the new and established outpatient, initial hospital and initial nursing facility visit codes.

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Confused about vaccine administration services?

Coding Advisory Board — Mon, 05 Apr 2010 15:28:31 -0500

Per CPT guidelines, you may only report one “initial” vaccine administration code per day, regardless of the route of administration. Simple, straightforward, and easy to understand…right?

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CY 2011 CMS-HCC Methodology Changes Announced

Coding Advisory Board — Mon, 05 Apr 2010 13:59:48 -0500

On February 19, 2010, CMS sent advance notice to Medicare Advantage Organizations regarding methodological changes for Calendar Year 2011 for Medicare Advantage capitation rates. The final announcement is scheduled for April 5, 2010.

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Researching Code History on MediRegs

Rayellen.Gilles — Thu, 25 Mar 2010 15:18:13 -0500

Step One for most coding audits is to gain a thorough understanding of the nature of the code under investigation. This should include the official long description, parenthetical notes, and a good understanding of the code history. This work is easy to do in the Coding & Revenue Resource Center and the Audit & Revenue Resource Center via the Code Explorer search engine. This article is a how-to guide for coding audit researches, and provides multiple best practice avenues for researching a code.

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Lag Time in Rulemaking for HITECH Act Addressed

Joanna.Maher — Mon, 22 Mar 2010 09:49:59 -0500

As many are aware, the February 17, 2010 effective date for many of the HITECH provisions has passed. This has left many covered entities and business associates wondering how to proceed. According to hhs.gov, the relevant effective dates for provisions will be issued through Notice of Proposed Rulemaking (NPRM) and an eventual final rule.

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Health Care Reform Passed by House

Lauren.vanderKeyl — Mon, 22 Mar 2010 08:47:09 -0500

The House of Representatives recently passed both H.R. 3590, the Patient Protection and Affordable Care Act and H.R. 4872, the Health Care and Education Reconciliation Act of 2010. The former, approved by the Senate in December, addresses a number of healthcare-related issues including employer responsibilities, private insurance, Medicare, Medicaid, prescription dugs, subsidies, etc. Having passed both the House and the Senate, the Affordable Care Act will now go to President Obama for his approval.

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CMS Enters the Realm of Social Media

Lauren.vanderKeyl — Fri, 19 Mar 2010 09:52:07 -0500

In an effort to bring information to a broader audience, the Centers for Medicare & Medicaid Services (CMS) is now employing social media sites Twitter, YouTube and LinkedIn.

To join the CMS LinkedIn group, go to: www.LinkedIn.com/in/CMSGov.

View a handful of informational videos by logging onto the CMS YouTube Channel at: www.YouTube.com/CMSHHSGov.

And for those looking for concise updates regarding CMS, can check out two Twitter accounts:

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ICD-10 PCS and Diagnosis CodeBook

Rayellen.Gilles — Mon, 15 Mar 2010 10:41:16 -0500

The 2010 ICD-10 Codebook is available in all Regulatory and Coding Suite products.   This is a breakdown of over 2000 pages of coding, mapping, and guidance information reformatted into an easy to search and browse book. As always, the 2009 archive version has been saved in the Archives libraries - available with other codebook archives in the Audit & Revenue Resource Center an Regulation & Reimbursement Suite. If you create bookmarks in the 2009 book, they should now autom

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AHA Says the "Meaningful Use" Bar Proposed by CMS Is Too High

admin — Tue, 09 Mar 2010 09:21:08 -0600

On March 8, 2010, the American Hospital Association (AHA) submitted comments to CMS on its proposed "meaningful use" rule.

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Reporting “Uncertain Tax Positions" by Albert Y. Lin, LLM, CPA

admin — Tue, 09 Mar 2010 08:53:42 -0600

Continuing a trend towards increasing detailed taxpayer disclosures (which tax-exempt healthcare providers have seen through the recently re-vamped Form 990), the Internal Revenue Service (IRS), in Announcement 2010-9, 2010-7 (Jan.

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What is the Problem with CBCs?

Coding Advisory Board — Fri, 05 Mar 2010 14:02:24 -0600

“Billing for services while operating in an environment of audit” has become my favorite catch phrase for 2010. It has been just over 7 years since the AMA updated the CPT descriptions for hematology procedures adapting the codes to current reporting practice of the clinical laboratory. Still in 2010, one of the most frequently billed outpatient tests continues to be incorrectly or inappropriately reported for reimbursement.

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Diabetes Self Management Training

Coding Advisory Board — Fri, 05 Mar 2010 13:48:14 -0600

Medicare covers diabetes outpatient self-management training when furnished by a certified provider who meets certain quality standards. A diabetes outpatient self-management training (DSMT) program includes education about self-monitoring of blood glucose, diet/ exercise, an insulin treatment plan developed specifically for the patient who is insulin-dependent, and motivation for patients to use the skills for self-management. The following is a guide explaining Medicare coverage requirements.

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MediRegs Customer Appreciation Event: April 19, 2010!

Lauren.vanderKeyl — Fri, 26 Feb 2010 11:43:56 -0600

“Experience Texas” at the MediRegs Customer Appreciation Event!

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Physician Quality Reporting Specifications Manual

Rayellen.Gilles — Wed, 10 Feb 2010 09:15:06 -0600

Are you participating in this important program? We've updated Code Explorer in Coding & Revenue Resource Center and Audit & Revenue Resource Center to make flagging PQRI codes a breeze.   The 2010 Specifications Manual contains details for each specific measure - simply click the GUIDANCE link from Code Explorer to see which measures any particular code falls into and tunnel in for details. Access the 2010 PQRI&nbsp

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CMS Changes E-Prescribing Codes for 2010

Coding Advisory Board — Mon, 08 Feb 2010 09:22:34 -0600

The Centers for Medicare and Medicaid Services made it easier this year to collect a bonus for Electronic Prescribing. For certain ambulatory services, CMS now requires only one “G” measure code to be submitted on a claim. The measure is required to be reported on only 25 claims for the reporting period to be eligible for the 2% bonus. This is much easier than last year, when CMS required that one of three measure codes be submitted on 50% of eligible claims.

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How to make more Microbiology money!

Coding Advisory Board — Wed, 03 Feb 2010 12:37:29 -0600

The micro lab has numerous “add on” procedures that are routinely performed to complete the culture report. Frequently, add on charges are never captured. There are several reasons for this – some process driven (such as bill drop dates coming too soon for the completion of all testing) and human errors (not submitting charges in a timely manner). One BIG reason is simply because bacteria do not grow at the whim of human time lines.

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OIG: Disclosure of Adverse Events Limited

Darci.Friedman — Wed, 27 Jan 2010 08:10:40 -0600

The Office of Inspector General (OIG) found that public disclosure of information about adverse events was limited, according to its review of 17 state adverse event report systems, eight Patient Safety Organizations overseen by the Agency for Healthcare Research and Quality (AHRQ), and the Centers for Medicare and Medicaid Services (CMS).

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Immediate Jeopardy Finding Fails Due To Lack Of Fact-Finding Specific Analysis

Darci.Friedman — Wed, 27 Jan 2010 08:03:13 -0600

A Department Appeals Board (DAB) order upholding the finding of an immediate jeopardy level violation and the imposition of $3,500 per day civil money penalty (CMP) against a skilled nursing facility (SNF) was vacated by the Eighth Circuit Court of Appeals because the DAB's finding was based on pure

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Help Identifying Changes in the Physician Fee Schedule RVU Files

Coding Advisory Board — Wed, 20 Jan 2010 09:04:18 -0600

CMS issues its changes to the Physician Fee Schedule quarterly, but how often do you have the chance to analyze it and review it? With over 15000 lines filling a spreadsheet, comparing each quarter’s changes can be a daunting and time consuming task. Are you aware that MediRegs does this for you? They issue a difference report every quarter that highlights the changes between the current version and the last quarter’s version. Look for the file called “Difference Report” and “MediRegs created.”

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Inpatient vs. Observation-Condition code 44

Coding Advisory Board — Tue, 29 Dec 2009 14:14:56 -0600

A conversation was recently had with a CMS representative regarding their policy and billing instructions associated with observation hours and services in situations when a patient is admitted as an inpatient but is subsequently found to be only eligible for observation; thus billed as an outpatient on the UB-04 reporting the Condition code 44.

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How to Query Providers to Achieve Complete Documentation

Coding Advisory Board — Tue, 29 Dec 2009 14:04:50 -0600

Coding professionals face increasing challenges to code claims accurately. Facilities can help ensure documentation integrity and coding accuracy by establishing and managing an effective query process. The importance of complete documentation in the patient’s health record cannot be overstated; without such documentation accurate coding cannot be assigned.

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Physician Supervision in the Hospital Outpatient Setting - Final 2010 OPPS Rule

Coding Advisory Board — Tue, 29 Dec 2009 13:50:42 -0600

CMS has revised or better defined several current policies for the supervision of outpatient services. The goal, per CMS, is “to ensure that hospital outpatient services are appropriately supervised by qualified practitioners while not impeding beneficiary access to these services, and in response to concerns raised by the hospital community.” In 2010, CMS will allow certain non-physician practitioners (NPP) (specifically physician assistants, nurse practitioners, clinical nurse specialists, certified nurse midwives, and licensed social workers) to provide direct super

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MediRegs' ComplyTrack Suite Named Finalist in Prestigious Software & Information Industry Association Awards

Darci.Friedman — Mon, 14 Dec 2009 09:07:29 -0600

MediRegs, a part of Wolters Kluwer Law & Business (mediregs.com), is pleased to announce that MediRegs ComplyTrack® Suite has been selected as a finalist in the 25 th annual Software & Information Industry Association CODiE Awards. The awards recognize excellence and innovation in information and software products and applications.

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Hot off the press! Eliminating consult code payments for 2010: Symposium Briefing

Coding Advisory Board — Sun, 15 Nov 2009 17:26:05 -0600

While attending the AMA Symposium this week there was a HUGE uproar about eliminating payments for consults. I thought one physician was going to take the head off of the guy from CMS! Whoa baby, talk about hot! Then you have the coders who are gunning for bear. The AMA left the CPT consult codes in for 2010 but CMS says they won’t pay! In light of this, the attending physicians are going to have to bill the initial hospital care day with a modifier. Then the consultants come along and they have to use the

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2010 Electronic Procedure Codebook is ready

Rayellen.Gilles — Tue, 10 Nov 2009 11:46:21 -0600

The Coding Suite team is pleased to announce that the 2010 HCPCS and CPT Codebook is available in pre-release format. Customers with access to the Coder's Resource Center, Coding & Revenue Resource Center, or Audit and Revenue Resource Center will find the link to the codebook on the Welcome tab (RRS customers, click on the Codebooks link on the left-hand navigation pane. Also, watch your Daily E-Mail Alert for the updates and changes report, a simple way to quickly see which codes have been added, deleted and modified. More tips for 2010 changes:

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Analysis of the 2010 CPT Code Changes

Coding Advisory Board — Fri, 06 Nov 2009 10:41:25 -0600

Fall is here, and along with the change in the weather comes the annual change to CPT codes.

Evaluation and Management: The E/M Guidelines at the beginning of the Evaluation and Management chapter were updated to expand the definition of Concurrent Care to include "Transfer of Care." The new definition reminds users to not use consultation codes when a transfer of care occurs, unless such transfer happens after the initial consultation evaluation.

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Drugs of abuse analysis: Proposed changes for 2010

Coding Advisory Board — Fri, 06 Nov 2009 10:27:52 -0600

Within the listing of 2010 HCPCS posted by CMS on November 2nd laboratorians will see two new G-codes that redefine coding of qualitative drug analysis billed to Medicare.

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Modifiers: It’s all about the money! – Part 2

Coding Advisory Board — Fri, 06 Nov 2009 09:33:09 -0600

In part 1 of this modifier series we identified and discussed the largest category—Global Package Modifiers, and the following modifier categories: GP, BUN, E/M only, #, Anes, Lab, and OTH. In part 2, we will explore the other categories of modifiers starting with the “BUN” grouping.

The following are the modifiers that relate to the bundling of CPT codes or related CCI edits:

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Seeing the "Gray" in E/M Coding, Part 2 - Review of Systems and Past Family Social History

Coding Advisory Board — Fri, 06 Nov 2009 08:57:22 -0600

In a previous blog I wrote, "Seeing the “Gray” in Evaluation and Management Coding – Chief Complaint and History of Present Illness," I had started a dialogue related to Chief Complaint (CC) and History of Present Illness (HPI) gray areas. In this edition I hope to continue the conversation as it relates to review of systems (ROS) and past family social history (PFSH).

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Timely Claim Filing Rules: Impact on Re-Billing Inpatient Ancillary Services

Coding Advisory Board — Wed, 04 Nov 2009 08:58:03 -0600

One of the more difficult issues facing hospitals today is related to the timely claim filing rules associated with re-billing ancillary charges for denied inpatient stays.

Under the RAC demonstration project, CMS allowed hospitals to re-bill their RAC denied inpatient short stay hospitalization cases as outpatient claims. The UB-04 claim type used to submit these claims for benefits was the traditional 13x; and Medicare Part B hospital benefit policies dictated coverage of services and payments.

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January 2010 Code Set Updates: HCPCS, APC, Phys Fee

Jennifer.Ridell — Wed, 04 Nov 2009 08:33:55 -0600

The 2010 HCPCS Level II update is now available in CCH Coding Comply. The updated data files became available on CMS’ website late Monday Night. It is anticipated that this update will be released in the HCPCS and CPT electronic code book in the Coding Suite and RRS sometime next week. When complete, a link will be provided in the “Hot Topics” box on the Welcome page of the Coding Suite.

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FTC Red Flags Rule Enforcement Delayed Until June 1, 2010

Lauren.vanderKeyl — Tue, 03 Nov 2009 08:51:46 -0600

The Federal Trade Commission has extended enforcement of the Red Flags Rule until June 1, 2010. Enforcement of the rule has been delayed previously as the FTC sought to adequately educate affected corporations and institutions. The Red Flags Rule impacts financial institutions and creditors subject to FTC jurisdiction. According to the Rule, created under the Fair and Accurate Credit Transactions Act, covered entities must develop and implement written policies that aid in identity theft prevention.

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Bloggity Blog - The New IT Standards Blog!

Darci.Friedman — Mon, 02 Nov 2009 15:44:00 -0600

The HIT Standards Committee met on October 29, 2009 and formed an "Implementation Workgroup" which is charged with bringing forward “real-world” implementation experience to the HIT Standards Committee recommendations. The Implementation Workgroup will have a special emphasis on strategies to accelerate the adoption of proposed standards, or mitigate barriers, if any. In addition to public meetings designed to uncover new strategies, the Committee also launched a blog. Industry groups, including the AHA, are encouraging hospital leader's to partic

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Home Health and DME hit the “most wanted” list in the Senate Finance Committee Bill

Maria.Bounos — Fri, 30 Oct 2009 22:25:16 -0500

Home Health and Durable Medical Equipment (“DME”) can’t seem to get out of the spotlight and who can blame the government for scrutiny. Back in the day when Home Health charged on a “per visit” basis, we saw independent Home Health agencies in abundance across the United States, company CEOs using Medicare dollars to purchase airplanes and living in mansions as they reaped the benefits of what was found to be Home Health fraud and abuse. In the late 90’s an “interim payment system” was implemented pri

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Still confused as to whether a visit is a consult or a referral?

Coding Advisory Board — Fri, 30 Oct 2009 14:24:28 -0500

Let’s take a look at the definition of a consultation. A consultation is a type of service provided by a physician or qualified provider whose opinion or advice regarding the evaluation and/or management of a specific problem is requested by another physician or provider. Another way of defining a consultation is a rendering of advice of your professional opinion, followed by a report of your findings to the referring physician.

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Hospital Services – A different mindset for documentation

Coding Advisory Board — Fri, 30 Oct 2009 10:00:16 -0500

As we have moved into a new era of CMS compliance measures, the importance of solid hospital coding and documentation is a must to avoid unnecessary audits. With the onslaught of RAC’s aggressively beginning to focus on hospital services around the country, training internal coding staff and physicians will be the key to survival. Criteria for hospital admission services (99221-99223) are frequently under documented by physicians. Further, the use of time (counseling & coordination

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Expanded Code Search Functionality

Rayellen.Gilles — Wed, 28 Oct 2009 06:33:16 -0500

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Senate Finance Committee Requests Answers From 3M Regarding Software Complaints

Nicole.Stone — Tue, 27 Oct 2009 12:22:10 -0500

In response to compliants from medical practitioners, patients, and technology engineers that Health Information Technology (HIT) and Computer Physician Order Entry Systems (CPOE) software programs are often faulty and that the manufacturers' shift blame to the medical facility when errors are found, Senator Grassley, on behalf of the Senate Finance Committee, sent a letter on October 16, 2009, to the CEO of 3M Company requesting information and documentation about 3M's software policies and programs.

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Secondary Infusion Coding: 96367 & 96368 Clarified

Coding Advisory Board — Fri, 02 Oct 2009 21:13:28 -0500

Since 2006 your facility has most likely provided numerous in-services and documentation reviews that focus on the need for clear and concise documentation of infusion services. The end result being the reduction of failed claims and enhanced compliance with CCI coding policies for selection of primary or “initial” procedure CPT. But what practices has your facility implemented to identify inaccurate code selection for sequential and concurrent IV infusions?

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Why do Providers Need to Know Coding Basics?

Coding Advisory Board — Fri, 02 Oct 2009 21:02:38 -0500

A comment I often hear by many physicians is “all I want to do is treat my patients.” The truth is that despite their tendency to avoid the topic, providers must take the responsibility for coding seriously. With the constant changes of our medical system, who other than the person treating the patient is best qualified to determine the correct code to use when submitting claims for reimbursement?

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E-Prescribing Incentive Program Changes

Coding Advisory Board — Fri, 02 Oct 2009 20:41:50 -0500

In July, the Centers for Medicare & Medicaid Services released proposed changes to the e-prescribing incentive program. The goal of the program is to incent prescribers to voluntarily adopt e-prescribing in the early years of the program and later in the program, penalize those who don’t adopt e-prescribing.

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Proposed 2010 E-Prescribing Incentive Program Changes

Coding Advisory Board — Fri, 02 Oct 2009 20:40:17 -0500

In July, the Centers for Medicare & Medicaid Services released proposed changes to the e-prescribing incentive program. The goal of the program is to incent prescribers to voluntarily adopt e-prescribing in the early years of the program and later in the program, penalize those who don’t adopt e-prescribing.

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Seeing the “Gray” in Evaluation and Management Coding – Chief Complaint and History of Present Illness

Coding Advisory Board — Fri, 02 Oct 2009 20:16:15 -0500

Being able to see and audit the "gray" areas of E/M coding is what separates coding professionals from other coders. It’s human nature to want absolute truth in all we do. But the savvy coder knows that especially when it comes to coding E/M services, there are few absolutes.

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CPT 2010 Update is Ready in CCH Coding Comply

Jennifer.Ridell — Fri, 02 Oct 2009 18:48:00 -0500

The 2010 CPT update will be available for export in CCH Coding Comply on October 3. The annual update includes more than 150 new codes. Some of the new codes cover complex cystometrogram (51727-51729), injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic (64490-64492), and computed tomographic (CT) colonography, screening, including image postprocessing (74261-74263). Additionally, over 170 codes were modified for 2010.

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CPT 2010 is Coming!

Jennifer.Ridell — Wed, 30 Sep 2009 19:30:37 -0500

We recently received the 2010 update files for CPT and are working hard to bring the information to you. Keep checking the MediBlog and CCH and MediRegs What's New publications for information regarding the availability of the 2010 update in our products. Aside from the standard CPT update data, the American Medical Association (AMA) released additional information this year pertaining to H1N1 codes and data structure.

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OIG Reports on Pandemic Flu and Medical Surge

Darci.Friedman — Wed, 23 Sep 2009 09:00:16 -0500

Are we ready for the impending flu season? What about an influenza pandemic? The OIG recently released a duo of reports addressing preparedness for an influenza pandemic.  In one of the reports, the OIG examined the extent to which states and localities have prepared for a medical surge in response to an influenza pandemic and whether they have conducted and documented exercises that test their medical surge

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What are your EMTALA obligations during a pandemic?

Darci.Friedman — Tue, 08 Sep 2009 10:42:23 -0500

Flu season is coming and concerns over an H1N1 resurgence are rising. To make sure hospitals understand their obligations under EMTALA during a disaster or a pandemic, CMS issued, on August 14, 2009, a Survey and Certification Letter. See CMS S&C-09-52. The letter has an attached Fact Sheet, which addresses planning for a surge in ED services and waiver rules.

Picking the right code—is it as easy as it appears?

Maria.Bounos — Fri, 04 Sep 2009 13:40:13 -0500

Coders learn early on “to assign procedural codes based on the documentation noted in the medical record.” Sound easy?

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Modifiers: It’s all about the money! - Part 1

Coding Advisory Board — Tue, 01 Sep 2009 09:07:07 -0500

Knowing what modifiers are available and when to use them can be quite confusing. Most modifiers have some effect on reimbursement so rather than review modifiers in numerical order it is helpful to consider them in groups related to their function and how they increase or decrease payment.

Modifiers do just that – they modify the code description without changing the core meaning. They are a way to provide additional information regarding a service and are integral to the CPT and HCPCS coding systems.

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When Does Observation Time Begin and End?

Coding Advisory Board — Mon, 31 Aug 2009 13:35:49 -0500

We all know that the term observation has many meanings and associated reporting guidelines depending upon the payer. One of the most significant questions is “when does observation time begin and end?” This sounds simple, but it is anything but that.

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ADM Users - Custom Fields

Carla Engle — Fri, 21 Aug 2009 14:10:48 -0500

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Join MediRegs on LinkedIn or Twitter

Darci.Friedman — Thu, 20 Aug 2009 10:54:58 -0500

Did you know that MediRegs has a User Group on LinkedIn? Did you know that you can follow MediRegs on Twitter? Check these great resources out and join us today!

Bone Biopsy vs. Aspiration Explained

Coding Advisory Board — Thu, 20 Aug 2009 07:56:30 -0500

A biopsy is a minimally invasive procedure; a means of percutaneously sampling potentially abnormal tissue and provide diagnostic information. Cells or a small amount of tissue is removed by placing a sterile needle into the area.

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E&M Coding Grids: Are You Aware of Recent Changes?

Coding Advisory Board — Wed, 19 Aug 2009 09:40:21 -0500

Many health care professionals use E&M coding grids to assist with the application of E&M codes. In it’s Evaluation and Management Services Guide, CMS indicates that for determining the complexity of medical decision making, “The number of possible diagnoses and/or the number of management options that must be considered is based on:

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2010 Medicare Physician Fee Schedule Proposed Rule Published

Coding Advisory Board — Sat, 15 Aug 2009 09:52:40 -0500

On July 1, the CMS released the proposed changes to the Medicare Physician Fee Schedule (MPFS). CMS updates the MPFS annually to set payment rates for physician and non-physician practitioner services. The press release is found on the Medical Release Database section within CMS: http://tinyurl.com/kqsdym.

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2010 Outpatient PPS Proposed Rule Published

Coding Advisory Board — Sat, 15 Aug 2009 09:44:41 -0500

On July 1, the CMS released the proposed policy changes for services provided in hospital outpatient departments and ambulatory surgical centers (ASC) for 2010, under the outpatient Prospective Payment System (OPPS). The press release is found on the Medical Release Database section within CMS: http://tinyurl.com/nmx88h.

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OIG Report on Qualifications of Nonphysicians Performing "Incident To" Services

Darci.Friedman — Thu, 13 Aug 2009 09:59:50 -0500

In a report issued on August 5, 2009, the OIG examined days that Medicare allows more than 24 hours of services billed by a single physician and sought to identify the services physicians bill to Medicare but do not perform personally and the qualifications of nonphysicians performing "Incident To" services. The OIG found that:

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Coding and Reporting Updates for the PQRI and E-Prescribing Programs

Nicole.Stone — Fri, 07 Aug 2009 10:58:49 -0500

A recent CMS Manual Transmittal provides a high-level overview of claims-based reporting for the 2009 physician quality reporting initiative (PQRI) and the E-Prescribing Incentive Program.

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Payment for Necessary and Reasonable Maintenance of Oxygen Equipment

Nicole.Stone — Fri, 07 Aug 2009 10:02:32 -0500

CMS has released clarification on payment for maintenance and servicing of certain oxygen equipment as a result of the Medicare Improvements for Patients and Privacy Act (MIPPA) of 2008. MIPPA established payment rules and supplier responsibilities related to the maintenance and servicing of oxygen concentrators and transfilling equipment.

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Advance Beneficiary Notice of Non-coverage (ABN)

Coding Advisory Board — Fri, 07 Aug 2009 09:36:42 -0500

The Centers for Medicare and Medicaid (CMS) require a provider to notify Medicare beneficiaries when a service may not be covered under the Medicare program. The new Advance Beneficiary Notice of Non-coverage (ABN), which became effective March 1, 2009, must be completed by the provider, or his/her representative, and signed by the patient, before a service is rendered.

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New Remittance Advice Remark and Claim Adjustment Reason Codes Now Available

Coding Advisory Board — Thu, 06 Aug 2009 11:59:14 -0500

Kathy Lindstrom, a professional coder at Provation and a CCH & MediRegs Coding Advisory Board member, has compiled a list below of the best resources your staff can use to implement the latest changes to the Remittance Advice Remark Codes (RARCs) and Claim Adjustment Reason Codes (CARCs) that became effective July 1, 2009.

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Sebelius Delegates HIPAA Security Authority to the OCR

Darci.Friedman — Tue, 04 Aug 2009 09:11:19 -0500

In a notice published in the Federal Register on August 4, 2009, Kathleen Sebelius, Secretary of the Department of Health and Human Services delegated authority to the Director of the Office of Civil Rights over the HIPAA Security rules. With this delegation, the OCR is responsible for interpreting and enforcing both the HIPAA Privacy and Security rules. The OCR can now impose civil money penalties, issue subpoenas, and make exception determinations. The delegation is effective immediately. See 74 FR 38630.

ICD to CPT Procedure Crosswalking

Rayellen.Gilles — Thu, 30 Jul 2009 09:47:45 -0500

We recognize how important it is to be able to "translate" ICD to CPT(R), and are troubled by the lack of a National official crosswalk.

The Coding Suite allows you to map codes - here are instructions and a more in-depth discussion of the issues surrounding code-to-code mapping.

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FTC Red Flags Rule Enforcement Delayed Until 11/1/2009

Lauren.vanderKeyl — Thu, 30 Jul 2009 09:27:56 -0500

In an effort to extend their Red Flags education campaign, the FTC has announced that enforcement on the Red Flags Rule will be delayed until November 1, 2009. This education campaign seeks to educate businesses on whether they are covered by the Rule, and if so, which steps to take in order to be compliant. Small businesses, in particular, had fumbled to grasp whether their risk-based programs were harmonious with the Red Flags Rule.

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Obama presents legislation for new Medicare rate-setting agency

Paul.Clark — Fri, 17 Jul 2009 15:50:05 -0500

President Obama on July 17 sent a draft of legislation to Congress that would establish an Independent Medicare Advisory Council (IMAC), which would have the authority to make recommendations to the President on annual Medicare payment rates as well as other reforms.

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Senate, House committees approve reform legislation

Paul.Clark — Fri, 17 Jul 2009 14:02:51 -0500

Comprehensive health care reform legislation passed a significant milestone last week as Senate and House committees approved different legislative packages. At the same time, comments from the head of the Congressional Budget Office (CBO) put a damper on the potential further progress of the legislation.

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State Privacy Regulation and EMR's

Darci.Friedman — Wed, 15 Jul 2009 12:26:02 -0500

The July issue of Management Science contains a study that "quantifies the effect of state privacy regulation on the diffusion of electronic medical records." The study, by Amalia Miller, Department of Economics, University of Virginia and Catherine Tucker, MIT Sloan School of Management, Massachusetts Institute of Technology, found that "state privacy regulation restricting hospital release of health information reduces aggregate EMR adoption by hospitals by more than 24%." To see the abstract, click

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Electronic Health Records Incentives under the Recovery Act

Rayellen.Gilles — Fri, 26 Jun 2009 06:38:08 -0500

Medicare has created a new FAQ Category for E-Health; Elecronic Health Records and has provided simple answers to common questions related to the Recovery Act financial incentives to encourage "meaningful use" of certified Electronic Health Records (EHR) among Medicare and Medicaid providers. They've included an estimated EHR timeline (with a rule expected late in 2009), their intention to provide "supportive programs" to assist providers with taking advanteage of the incentive program, and eligibility information.

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House Democrats Unveil Draft of Health Care Reform Legislation

Paul.Clark — Tue, 23 Jun 2009 07:51:29 -0500

House Democratic leaders unveiled a comprehensive health care reform plan on June 19, calling for the establishment of a public health insurance program that would compete with private insurers to lower costs. The proposal would create a Health Insurance Exchange to provide a functional marketplace for individuals and small employers to comparison shop among private and public insurers.

Few details of how the plan would be paid for were announced, and lawmakers said they were awaiting estimates from the Congressional Budget Office.

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Interesting Trend in NCCI Edits

Rayellen.Gilles — Thu, 18 Jun 2009 13:56:13 -0500

The number of active NCCI edits increased significantly this year.

We saw a near doubling of physician edits last quarter, with hospital CCI edits quickly converging to match the physician version.

If you have updateable NCCI tools, that means you are going to see many more codes involved in edits. If you rely solely on paper-based updates published yearly, the content that hit the presses last fall will be remarkably inaccurate for the 2nd half of 2009.

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Crowding In Hospital Emergency Departments Continues To Occur

Darci.Friedman — Tue, 16 Jun 2009 12:21:54 -0500

Emergency department crowding continues to occur in hospital emergency departments, and some patients wait longer than the recommended time frames, according to a recent study by the Government Accountability Office (GAO).

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ICD-9-CM 2010 Update Now Available

Jennifer.Ridell — Wed, 10 Jun 2009 18:50:14 -0500

The October 1, 2009, updates to the ICD-9-CM volume 1 and volume 3 code sets have been released via the ICD-9-CM Tabular Addenda and the FY 2010 Final Addenda. An ICD-9-CM code is required for all professional claims and for all institutional claims; however, an ICD-9-CM code is not required for ambulance supplier claims. New procedure codes include: 17.51, 33.73 and 46.87 and new diagnosis codes include: 209.70, 453.50, and V15.52.

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House, Senate release health care reform drafts

Paul.Clark — Tue, 09 Jun 2009 14:52:28 -0500

Members of both the House and the Senate have released draft summaries or draft legislative language for comprehensive health care reform legislation. Staff members of three House committees -- Ways and Means, Energy and Commerce, and Education and Labor – released a three-page summary of a possible health care reform bill that includes a public insurance option, insurance market reforms, and insurance premium support for families up to 400 percent of the federal poverty level.

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Inappropriate Part D Payments for Part A SNF Beneficiaries

Darci.Friedman — Mon, 08 Jun 2009 09:40:39 -0500

The OIG recently released a report entitled "Medicare Part D Payments For Beneficiaries In Part A Skilled Nursing Facility Stays In 2006."  The purpose of the review was to determine the extent to which Medicare Part D paid for drugs for beneficiaries in Part A SNF stays in 2006. The OIG found that Part D payments were widespread among SNFs and ph

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Obama may use MedPAC to fast-track Medicare changes

Paul.Clark — Wed, 03 Jun 2009 14:39:35 -0500

President Obama is looking at making the recommendations made by the Medicare Payment Advisory Commission (MedPAC) each year easier to put into effect. In a letter to Sens. Edward Kennedy (D.-Mass.) and Max Baucus (D.-Mont.) sent June 2, Obama outlined several proposals to cut health care spending over the next 10 years, particularly in the Medicare program.

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DHHS and DOJ Turn on the HEAT

Darci.Friedman — Tue, 02 Jun 2009 12:19:21 -0500

On May 20, 2009, Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius announced the creation of a new interagency effort, the Health Care Fraud Prevention and Enforcement Action Team (HEAT), to combat Medicare fraud. Holder and Sebelius also announced the expansion of Strike Force team operations to Detroit and Houston. Medicare Fraud Strike Forces, currently in operation in South Florida and Los Angeles, fight Medicare fraud on a targeted local level.

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OIG Advisory Opinion on Compensating On-Call Physicians

Darci.Friedman — Wed, 27 May 2009 08:30:00 -0500

On May 21, 2009, the OIG posted an advisory opinion regarding a proposal to compensate physicians for on-call services performed on behalf of it’s uninsured patients. Although the OIG acknowledged the legitimate reasons for such arrangements, they also stated there is a substantial risk that improperly structured payments for on-call coverage could be used to disguise unlawful remuneration. However, the key inquiry is whether the compensation is: (i) fair market value in an arm’s-length transaction for actual and necessary items

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Surgery for diabetes

Jennifer.Ridell — Thu, 21 May 2009 16:14:05 -0500

CMS has determined that open and laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and open and laparoscopic biliopancreatic diversion with duodenal switch in Medicare beneficiaries who have type 2 diabetes mellitus (T2DM) and a body mass index (BMI) less than 35 is no longer considered reasonable and necessary. It has been determined that these same procedures do improve health in patients with T2DM with a BMI greater than 35 so they are still considered reasonable and necessary in those situations.

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Healthcare reform may draw on Massachusetts model

Paul.Clark — Thu, 21 May 2009 08:24:30 -0500

As Congress and the Obama administration consider reform of the healthcare system, they may consider the experience

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Type of Service Data

Rayellen.Gilles — Wed, 20 May 2009 10:34:56 -0500

A smart client asked "What is the BETOS Data?   Can you give me a hint of what it is and how is it used?"

I'd like to answer that question, but also ask YOU a question in response!

My QUESTION is: How can we improve the existing tools in the Coding Suite to make it easier for you to view information by specialty/type of service? We already offer bookmarking and personal stored searches, and each tool lets you enter lots of codes at once, but what are we missing? Comment or contact me directly if you are interested in helping us improve!

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Routine Cost of Clinical Trials

Jennifer.Ridell — Tue, 19 May 2009 17:50:50 -0500

CMS has decided there is no longer a need to distinguish between diagnostic and therapeutic clinical trial services. This decision by CMS goes into effect July 10, 2009 and applies to all claims submitted with dates of service on or after January 1, 2008. The ICD-9 diagnosis code of V70.7 is still required to be reported on all claims that were submitted with either the QV or Q1 modifier.

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Product Enhancement - Find the Codes that are Current TODAY

Jennifer.Ridell — Tue, 05 May 2009 16:36:39 -0500

Wolters Kluwer Law & Business is excited to announce recent enhancements to the CCH Coding Comply product that is available via the CCH Internet Research Network and the CCH and MediRegs Coding and Revenue Resource Center and Audit and Revenue Resource Center.

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Hospitals face practically zero update in 2010

Paul.Clark — Mon, 04 May 2009 11:01:05 -0500

Acute care hospitals will receive a net 0.2 percent increase in payments for inpatient hospitals services in fiscal year (FY) 2010 under the proposed rule for the inpatient hospital prospective payment system (IPPS). Hospitals face a net decrease in payments in FY 2011 and 2012 under the proposed rule.

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Red Flag Rule Delayed until August 1, 2009

Joanna.Maher — Fri, 01 May 2009 09:41:56 -0500

FTC announced on April 30, 2009 that the enforcement of the Red Flag Rule will be delayed until August 1, 2009. This will allow time for creditors and financial institutions to create and fine tune their identity theft prevention programs. A template has also been developed and will be available soon which will aid companies with a low risk of identity theft.

More information is available from here: http://www.ftc.gov/opa/2009/04/redflagsrule.shtm

NCCI, MUEs and OCE

Rayellen.Gilles — Wed, 29 Apr 2009 16:23:17 -0500

We've noticed that the NCCI code pairs in the physician version for 04/01/2009 have nearly doubled this quarter! For this and other customer requests, we held a webinar today on NCCI and MUE. Check the What's New in the product for the Study Aid in the MediNotes collection. There you will also find a copy of the presentation slides. Comment to this posting if you have any follow up questions, want to make comments, or wish to start a deeper dialogue about NCCI Issues!

Bariatric Surgery for Diabetes

Jennifer.Ridell — Thu, 23 Apr 2009 14:39:01 -0500

CMS has determined that open and laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and open and laparoscopic biliopancreatic diversion with duodenal switch in Medicare beneficiaries who have type 2 diabetes mellitus (T2DM) and a body mass index (BMI) less than 35 is no longer considered reasonable and necessary. It has been determined that these same procedures do improve health in patients with T2DM with a BMI greater than 35 so they are still considered reasonable and necessary in those situations.

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HHS Guidance on Protecting Health Information

Darci.Friedman — Tue, 21 Apr 2009 07:57:33 -0500

On April 17, 2009, HHS issued guidance specifying the technologies and methodologies that render protected health information unusable, unreadable, or indecipherable to unauthorized individuals, as required by the Health Information Technology for Economic and Clinical Health (HITECH) Act passed as part of the American Recovery and Reinvestment Act of 2009. The guidance was developed through a joint effort by OCR, the Office of the National Coordinator for Health Information Technology, and CMS.

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Increasing Cashflow and Strengthening the Bottom Line

Rayellen.Gilles — Fri, 17 Apr 2009 15:51:15 -0500

I want to extend a special thank-you to Vickie Fry from Prospective Payment Specialists (http://www.ppscompliance.com/) for her great presentation 04/16. The Study Guide is now available, and we invite your comments. If you attended and would like to provide feedback please click on the COMMENT link associated with this article.

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Article provides clues on views of new HIT coordinator

Paul.Clark — Fri, 17 Apr 2009 14:29:08 -0500

In late March the Obama administration named David Blementhal, physician and director of the Institute for Health Policy at the Massachusetts General Hospital/Partners Healthcare System as the national coordinator for health information technology (HIT). This new post was included in the recently enacted American Recovery and Reinvestment Act of 2009 (ARRA).

In his new role, Blumenthal will be responsible for determing how almost $20 billion in new funding will be disbursed over the next few years.

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Changes to DMEPOS competitive bidding program in effect April 18

Paul.Clark — Fri, 17 Apr 2009 13:35:13 -0500

The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), enacted on July 15, 2008, made limited changes to the competitive bidding program for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS), including a requirement that the Secretary conduct a second competition to select suppliers for Round 1 in 2009.

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Red Flags Rule: Fighting Identity Theft

Lauren.vanderKeyl — Mon, 06 Apr 2009 09:15:03 -0500

On January 1, 2008, the newly-released Red Flags Rule stipulated that certain businesses are required to "spot and heed" the red flags for identity theft. Health care providers, in particular, should be vigilant in monitoring any suspicious activity that may indicate identity thieves have accessed stolen information including social security numbers, birth dates, account numbers, etc. in order to acquire accounts or services. Compliance to the Red Flags rule will be enforced starting on May 1, 2009. Is your organization covered?

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CMS to host RAC teleconference

Paul.Clark — Thu, 02 Apr 2009 15:53:21 -0500

CMS is hosting a Special Open Door Forum teleconference for Part A provider Recovery Audit Contractors (RACs) on April 8, 2009, from 2:00 to 3:30 EST. The purpose of the forum is to introduce providers to the new RACs and provide more information about the RAC program.

CMS notes that capacity is limited; participants may may begin dialing into this forum as early as 1:45 PM EST. Dial: 1-800-837-1935 and reference Conference ID 92490299.

Twenty percent of Medicare inpatients rehospitalized within 30 days

Paul.Clark — Thu, 02 Apr 2009 14:18:26 -0500

Unplanned rehospitalizations of Medicare beneficiaries within 30 days leaving the hospital cost the program $17.4 billion in 2004, according to a study published April 2 on the web site of the New England Journal of Medicine. This equals about 17 percent of all hospital payments from Medicare in 2004. Almost one-fifth (19.6 percent) of beneficiaries discharged from a hospital that year were rehospitalized within 30 days. Only about 10 percent of these rehospitalizations were planned.

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Physician Groups Press FTC For Exemption From Red Flag Rules

Darci.Friedman — Wed, 25 Mar 2009 05:32:46 -0500

With a May 1st deadline for compliance looming, the American Medical Association (AMA) has asked the Federal Trade Commission (FTC) to suspend the application of the Red Flag Rules to physicians and publish a new rule so that physicians have an opportunity to provide comments. In a March 9 letter to the FTC, AMA Executive Vice President Michael D. Maves wrote that the AMA “strongly believes that the FTC did not provide physicians with an opportunity to review and comment on this Rule.”

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Use Risk-Remediation Process; Focus on Areas in Broad Categories

Darci.Friedman — Mon, 23 Mar 2009 04:26:16 -0500

Recently, MediRegs' own GM Steve Lefar and William Moran (of Strategic Management Services), a former regional HHS Inspector General, were interviewed by Atlantic Information Services on a method of approaching risk assessment and remediation. "While you want to be able to deal with all of your risks, you have to make some choices. You don’t have enough staff to look at everything all the time," Moran says. Moran and Lefar identified the ten most pressing risks within some general risk categories. To see the entire article click here.

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OIG Report on Hospital Compliance with Postacute Care Transfer Policy

Darci.Friedman — Mon, 16 Mar 2009 03:35:57 -0500

Medicare's postacute care transfer policy pays full DRG payments to hospitals for patients discharged to home. Medicare pays hospitals that transfer patients to postacute care settings (e.g., skilled nursing, home health care) a per diem rate. In a recent audit report, the OIG found that of 150 claims sampled, 92 of them were improperly coded as discharges to home rather than transfers to postacute care settings. The OIG noted that multiple prior reports have found that hospitals are not complying with the postacute transfer policy. Perhaps it is time for your hospital to audit its compliance with the policy? See OIG Report A-04-07-03035 (February 2009).

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ICD-10 Final Rule is Moving Again

Jennifer.Ridell — Thu, 05 Mar 2009 09:23:18 -0600

The final rule to implement the ICD-10 code set, which was released on January 16, 2009 and them promptly put on hold by the Obama Administration on January 21, 2009 for further review, has been officially released. It has been determined that the effective date will not be extended and the comment period will not be re-opened.

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Electronic Health Records, Friend or Enemy?

Jennifer.Ridell — Thu, 05 Mar 2009 09:01:41 -0600

I'm all for saving money and making things easier, at least when it doesn't publicize my Dr's finding from my latest physical.

M. Eric Johnson who is the director of the Center for Digital Strategies at Dartmouth College discovered a number of medical records available for public view during a two week study he completed in January for the Department of Homeland Security. Amazingly these files were available for the taking on peer-to-peer file sharing networks you and I would visit to download our favorite song.

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May 1st Is Fast Approaching - Are You Red Flag Ready??

Darci.Friedman — Thu, 26 Feb 2009 08:01:44 -0600

On May 1, 2009, the FTC's six month suspension of the enforcement of the Red Flag Rules will be lifted. Is your organization's Identity Theft Prevention Program in place? If not, review the requirements at 16 CFR 681 on the MediRegs research portal. If your organization has implemented a program - be sure it passes compliance muster by conducting the Red Flag Rules risk assessments developed by MediRegs for ComplyTrack. Question sets include:

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Ingenix at Root of another Reimbursement Fraud Case

Nicole.Stone — Wed, 25 Feb 2009 04:33:58 -0600

On February 17, 2009, WellPoint Inc. agreed to stop using the Ingenix database of reimbursement rates that New York Attorney General Andrew Cuomo called “defective and manipulated.”

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HIPAA and the Stimulus Bill

Joanna.Maher — Tue, 24 Feb 2009 07:13:31 -0600

By now you've probably heard the rumblings surrounding HIPAA and the new Stimulus Bill signed by President Obama on February 17, 2009. If not, the effect the bill is going to have on business associates and covered entities is extensive. Numerous changes will be made to their current policies and procedures.

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Stimulus law provides funds for "comparative effectiveness research"

Paul.Clark — Wed, 18 Feb 2009 11:25:23 -0600

One of the provisions of the "American Recovery and Reinvestment Act of 2009'," signed into law by President Obama on Feb. 17, 2009, that has received a lot of often negative attention in some parts of the media relates to "comparative effectiveness research."

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Two Self-Referral Exceptions Recommended by Hospital Groups

Darci.Friedman — Wed, 18 Feb 2009 05:37:00 -0600

On February 17, 2009, the American Hospital Association, Association of American Medical Colleges and Federation of American Hospitals submitted a comment letter to CMS recommending two new exceptions to the physician self-referral law - exceptions for incentive payment and shared-savings programs. At the same time, the hospital groups also submitted a letter to the OIG asking for formal withdrawal of the 1999 Special Bulletin regarding gainsharing arrangements. The letters address CMS final rule with comment

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IRS Report on Nonprofit Hospitals

Darci.Friedman — Fri, 13 Feb 2009 04:11:44 -0600

Recently, the IRS released a final report on its 2006 nonprofit hospital study, which analyzes community benefit and compensation reporting by almost 500 hospitals. The IRS found that the average and median percentages of total revenues reported as spent on aggregate community benefit expenditures were 9% and 6%, respectively, for the overall group. AHA President and CEO Rich Umbdenstock said, “Today’s IRS report reaffirms that hospitals of all types are providing a healthy mix of care and services to the communities they serve.

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Medicare, Medicaid and health IT provisions key part of final stimulus bill

Paul.Clark — Wed, 11 Feb 2009 13:00:48 -0600

Late on Wednesday, Feb. 11, the House and Senate reached agreement on final language for the American Recovery and Reinvestment Act. President Obama is expected to sign the bill into law as soon as it reaches his desk. An unofficial summary of the conference agreement includes the following health-related provisions --

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Senate, House include similar health provisions in stimulus bills

Paul.Clark — Tue, 10 Feb 2009 12:39:37 -0600

Both the Senate and House have passed different versions of an economic stimulus bill. In addition to tax cuts and new government spending provisions, both bills include many provisions that affect healthcare providers. A conference committee will meet this week in an attempt to iron out the differences.

According to a fact sheet from the Senate Finance Committee, here are some of the key differences in the two bills, relating to healthcare.

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Permanent RAC program roll-out resumes

Paul.Clark — Tue, 10 Feb 2009 05:29:37 -0600

CMS announced on Feb. 4, 2009, that all parties involved in the protest of the award of the Recovery Audit Contractor (RAC) contracts settled their protests. The settlement means that the stop work order has been lifted and CMS will now continue with the implementation of the RAC program.

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Stimulus to Include Regulations on Charity Care and Not-For-Profit Hospitals?

Darci.Friedman — Mon, 09 Feb 2009 03:56:47 -0600

Sens. Chuck Grassley (R-Iowa) and Jeff Bingaman (D-NM) propose amendments to the economic stimulus bill "intended to ratchet up the scrutiny on charity care and not-for-profit hospitals" says ModernHealthcare.com. The Wall Street Journal Health Blog reports that "[o]ne Grassley-sponsored amendment would require the Treasury department (which includes the IRS) to compare the amount of uncompensated care and executive compensation provided at nonprofit versus for-profit hospitals.

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HIPAA and Privacy of PHI

Darci.Friedman — Fri, 06 Feb 2009 03:34:19 -0600

A recent article in HealthDay discusses an Institute of Medicine report on personal health information. "The privacy of Americans' personal health information isn't adequately protected by existing federal government regulation, according to an Institute of Medicine report. The Health Insurance Portability and Accountability Act (HIPAA) privacy rule also hinders important health research, the report's authors said.

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CMS, Congress To Ramp Up Quality Enforcement In 2009

Darci.Friedman — Thu, 05 Feb 2009 03:34:26 -0600

CMS and Congress will be focusing more on regulatory compliance matters in 2009 than they have in years, according to Brian Flood, managing director at KPMG. "You have a lot of activity going on in the next six months," he said during a recent American Bar Association teleconference.

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President Obama puts ICD-10 Final rule on hold

Jennifer.Ridell — Fri, 23 Jan 2009 09:51:08 -0600

On Wednesday, January 21st, the Obama Administration put the ICD-10 final rule, along with others that are pending, on hold while further review is conducted. Don’t start cheering yet!

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Obama administration review may delay pending regulations

Paul.Clark — Thu, 22 Jan 2009 08:18:54 -0600

One of the first actions of the new Obama administration was to issue an order to undertake a legal and policy review of all regulations issued by the executive that have not yet gone into effect. The review may push back the effective dates of several regulation issued by CMS and HHS, or lead to their repeal. The Bush administration issued a similar directive when it first took office, suspending the effective dates for several final rules issued in the last days of the Clinton administration.

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OIG Approves Wisconsin FCA, Rejects New Jersey Statute

Darci.Friedman — Thu, 22 Jan 2009 08:07:06 -0600

As officials in Wisconsin received a letter from the Office of Inspector General indicating that the state's false claims act meets the requirements of the Deficit Reduction Act of 2005, New Jersey officials learned that their false claims statute will have to be amended for the state to become eligible for an increase in its share of Medicaid false claim recoveries. OIG determined that New Jersey's false claims statute is not as effective in rewarding and facilitating qui tam actions as the federal False Claims Act.

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New APC Grouping Logic for 2009

Rayellen.Gilles — Tue, 20 Jan 2009 04:06:52 -0600

Important Notice: Addendum A & B were posted 01/02/2009 by CMS. CMS issued a notice to FI/MACs to hold Outpatient claims until 1/15/2009.

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Senate Finance panel approves SCHIP extension, expansion

Paul.Clark — Mon, 19 Jan 2009 07:47:00 -0600

The Senate Finance Committee on January 15 approved legislation to renew and expand the State Children’s Health Insurance Program (SCHIP) by a vote of 12 to 7. The $31.5 billion measure funds investment in the SCHIP program with a 61 cent increase in Federal tax on cigarettes, with proportional increases for other tobacco products, raising approximately $65 million over 10 years. The House passed a similar measure (HR 2) on January 14 by a vote of 289-13. The full Senate is expected to take-up its version during the week beginning January 19.

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ICD-10 - Is it finally ready?

Jennifer.Ridell — Fri, 16 Jan 2009 12:07:45 -0600

It looks like there finally is an official plan to implement the ICD-10 code set in the United States.

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House offers stimulus package with more Medicaid spending

Paul.Clark — Thu, 15 Jan 2009 07:40:59 -0600

The House Appropriations Committee on Jan. 15 issued the outline for an $825 billion stimulus package which includes several provisions relating to Medicare and Medicaid.

The proposal (for which actual legislative text is still being written) would provide $8.6 bilion to provide 100 percent federal funding to states through 2010 for optional state Medicaid coverage of individuals and their dependents who are involunitarily unemployed and whose income is no higher than 200 percent of the federal poverty level.

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House passes SCHIP reauthorization bill

Paul.Clark — Wed, 14 Jan 2009 11:05:50 -0600

The House of Representatives on Jan. 14 passed, by a 289 to 139 vote, HR 2, the State Children's Health Insurance Program (SCHIP) Reauthorization bill. The legislation is intended to expand the number of children covered by health insurance under SCHIP or Medicaid from 7 million to 11 million.

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Ingenix at Root of Reimbursement Rate Fraud?

Nicole.Stone — Wed, 14 Jan 2009 06:24:51 -0600

On January 13, 2009, Attorney General Andrew M. Cuomo announced that Ingenix was at root of fraud scheme and that as a result a historic reform of the nationwide health care reimbursement system is needed that will end conflicts of interest and generate fair reimbursement rates for working families nationwide.

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Congress will not act on Medicare "trigger" in 2009-2010

Paul.Clark — Fri, 09 Jan 2009 09:22:23 -0600

The 111th Congress, which will meet in 2009 and 2010, will not consider anylegislation that would enact reductions in Medicare financing from the Treasury'sgeneral revenues.

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Court Prohibits Balance Billing in CA

Darci.Friedman — Fri, 09 Jan 2009 02:58:25 -0600

"California's high court ruled that emergency-room patients can no longer be billed by doctors and hospitals for care that isn't fully paid by their health plans. The court on Thursday struck down a practice known as 'balance billing,' in which doctors and hospitals seek to collect from patients any amounts that their managed-care plans refuse to pay.

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Revised Disclosure of Financial Relationships Report Form Submitted to OMB

Darci.Friedman — Wed, 07 Jan 2009 09:53:19 -0600

On December 12, 2008, CMS published notice in the Federal Register that it had submitted a revised Disclosure of Financial Relationships Report ("DFRR") audit form to the Office of Management and Budget for review ("OMB").  The DFRR form will be used by CMS to identify arrangements that potentially may not be in compliance with the physician self-referral statute/regulations and to identify examples and areas of noncompliance that may assist CMS in f

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Providers successfully appeal 7.6 percent of RAC overpayment determinations

Paul.Clark — Wed, 07 Jan 2009 05:39:37 -0600

Healthcare providers involved in CMS's three-year recovery audit contractor (RAC) demonstration program successfully appealed 7.6 percent of overpayment determinations. The demonstration program ended in March 2008. From the inception of the RAC demonstration through August 31, 2008, providers chose to appeal 22.5 percent (118,051) of the RAC determinations.

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NCCI Edits for Anesthesiology, Evaluation & Management, and Mental Health Services

Rayellen.Gilles — Thu, 25 Dec 2008 03:24:52 -0600

In the past, the Outpatient Code Editor (OCE) has not applied the NCCI edits for the following categories of services: anesthesiology, evaluation and management, and mental health services. Effective 1/1/09, these categorical exclusions will be removed and there will be a large number of new institutional (hospital) NCCI edits applied to claims.

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APC and Clinical Lab - Wondering about the January 1 updates?

Jennifer.Ridell — Thu, 18 Dec 2008 00:00:00 -0600

We were wondering ourselves last week when the APC and Clinical Lab code set updates would be realeased. Our curiosity got the better of us so I reached out to a couple contacts at CMS and got information on these elusive January 1 updates. According to CMS they were still waiting on ASP data before they could finalize their APC file for 1/1/2009. The ASP data was released this week so we can expect the release of the APC data soon.

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Medical Coding - It Still Needs a Human Touch

Jennifer.Ridell — Thu, 18 Dec 2008 00:00:00 -0600

Automate! Automate! Automate! That seems to be the call across most industries these days. How can we automate job x, y, and z?

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Medicare, Social Security to hit 18 percent of GDP without changes

Paul.Clark — Wed, 17 Dec 2008 09:09:11 -0600

The Treasury Department and the Office of Management and Budget released on December 15, 2008 the Fiscal Year 2008 Financial Report of the United States Government, projecting that over the next two decades, Social Security and Medicare expenditures will increase from 8 percent of GDP to about 11 percent. Without reform, the cost of these programs is projected to approach 18 percent of GDP by 2080. Medicare, Medicaid, and Social Security accounted for 16 percent of total government expenditures 40 years ago.

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2009 Physician Quality Reporting Initiative Measures

Rayellen.Gilles — Wed, 17 Dec 2008 07:22:25 -0600

CMS has issued the 2009 PQRI Specifications Manual for Claims and Registry (v 3.0). This identifies the 153 measures for 2009. The complete manual is available for download in the CMS PQRI collection which can be found in the CMS - Coding Guidance library.

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CMS proposes new NCDs on preventable surgical errors

Paul.Clark — Thu, 04 Dec 2008 09:08:45 -0600

CMS on Dec. 2, 2008, proposed three national coverage determinations (NCDs) to establish uniform national policies that will prevent Medicare from paying for certain serious, preventable errors in medical care. The errors, also referred to as “never events,” include:

-- wrong surgical or other invasive procedures performed on a patient;

-- surgical or other invasive procedures performed on the wrong body part; and

-- surgical or other invasive procedures performed on the wrong patient.

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HIPAA Violation, Not Age Bias, Caused Hospital Employees’ Discharges

Darci.Friedman — Wed, 03 Dec 2008 16:11:33 -0600

Two employees over the age of 40 who were fired for violating a hospital’s confidentiality policy failed to show they were discharged because of their age under the ADEA or Kentucky law or that the hospital’s cost-cutting measures targeting higher-paid workers with seniority had a disparate impact on older employees, held the Sixth Circuit Court of Appeals. (Allen v. Highlands Hosp. Corp., 6th Circuit)

FTC Official Explains Identity Theft Red Flag Rule

Darci.Friedman — Mon, 24 Nov 2008 12:01:34 -0600

The “Identity Theft Red Flag Rules” (Rules) impose mandatory compliance with the regulations that require financial institutions or creditors to establish (1) protocols on discrepancies between an address requested in a consumer report and the address in the consumer reporting agency's file, and (2) policies and procedures to assess the validity of a change of address.

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The Physician Fee Schedule Code Set 2009 Update Has Been Released!

Nicole.Stone — Fri, 21 Nov 2008 14:29:43 -0600

CMS recently released the Physician Fee Schedule code set update in conjunction with the Physician Fee Schedule Final rule, which was published in the Federal Register on November 19, 2008. This code set update becomes effective January 1, 2009.

This code set update includes several new surgical laparoscopy procedures (49652-49657) and stereotactic radiosurgery procedures (61796-61800) and modified skin debridement and benign lesion excision procedures with updated payment rates and RVU values (11004-11012 and 11404, 11406, 11420-11426, respectively).

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Updated: New features coming to MediRegs search results

Joy.Woller — Fri, 21 Nov 2008 10:09:10 -0600

MediRegs is excited to release an improved search results screen for our research products Wednesday, Nov. 26th. Here's a quick tour:

Excerpts of the text surrounding your search terms appear below each document link.

You can control the number and size of excerpts displayed with each search result using the "Search Settings" control, or opt to hide them altogether.

The location of the document within a particular collection is displayed in an easy-to-read format.

Don't see exactly what you're looking for in the results? You can opt to browse the collection using the link above the results.

These changes are the first of many planned improvements to the Rex platform that lives under our many great research products. Most feature and design changes we make to our products come directly from user feedback. What else would you like to see?

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OIG Reviews a Pair of State False Claims Acts

Darci.Friedman — Mon, 17 Nov 2008 09:30:30 -0600

Wisconsin FCA Passes Muster With OIG

The OIG, on November 4, 2008, found that the Wisconsin False Claims Act meets the requirements of the Deficit Reduction Act, thus entitling Wisconsin to an increase of 10 percentage points in the State medical assistance percentage with respect to any amounts recovered under a State action brought under such a law.

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OIG Permits Prescription Drug Proposal

Darci.Friedman — Thu, 13 Nov 2008 09:12:27 -0600

The Office of Inspector General (OIG) would not impose sanctions related to a proposed arrangement that would allow a charitable organization to provide financial assistance to cover cost-sharing obligations associated with outpatient drug treatment for financially needy Medicare or Medicaid patients and was reliant upon donor funds, because it was designed with sufficient safeguards.

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Alabama sues CMS over alleged illegal administrative regulation

Paul.Clark — Tue, 11 Nov 2008 08:43:50 -0600

The state of Alabama on Nov. 3, 2008, sued CMS for what it called “illegal rulemaking” concerning a letter the agency sent to all states on October 28 setting guidelines for states to reimburse the federal government for amounts states gained from suits filed under a state Medicaid False Claims Act. In the suit, Alabama claims the requirements outlined in the letter (1) constitute illegal rulemaking in violation of the Administrative Procedure Act; (2) are in excess of CMS’ statutory authority; and (3) would violate state sovereignty.

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2009 HCPCS Level II Coding Update Has Been Released!

Nicole.Stone — Fri, 07 Nov 2008 09:36:23 -0600

The 2009 HCPCS level II annual update has been released! This update includes approximately 140 new codes, 178 modified codes and 73 deleted codes.

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Six Financial Arrangements Successfully Pass OIG Scrutiny

Darci.Friedman — Wed, 05 Nov 2008 10:06:37 -0600

In six recently released advisory opinions, the Office of Inspector General (OIG) gave clearance to several programs and financial arrangements, finding that sufficient safeguards had been put in place to prevent violations of the Social Security Act and the anti-kickback statute. The OIG announced that the following arrangements would not be subject to civil monetary penalties or sanctions:

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Technical Support: Making a product page one of your browser "Favorites"

Rayellen.Gilles — Fri, 31 Oct 2008 11:45:26 -0500

You can add a page within one of the Rex products like RRS to your internet browser favorites for instant access. To do this:

1) Sign In to the product

2) On the "You have access to the following products" screen, click on a product button.

3) Navigate to the tab or link on the leftnav that is your favorite.

4) Use your browser features to set this as a favorite. (Notice how the address bar shows where you are, including the "view" and other details.)

Additional tips...

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Retired LCDs Pose a New Problem for Clinical Laboratories

Nicole.Stone — Wed, 29 Oct 2008 11:32:22 -0500

The retirement of a LCD is considered by many to be a blessing rather than a problem because while a LCD is active, claims denials are automatic if the requirements of the LCD are not met. This forces the provider to obtain an advance beneficiary notice (ABN). Further, laboratories must maintain a database of LCD edits and update them when LCDs change or new ones are issued. Many think this all goes away when a LCD is retired. Think again!

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Medical Associations Challenge FTC's Interpretation Of "Red Flag" Rules

Darci.Friedman — Wed, 29 Oct 2008 10:20:46 -0500

American Medical News Article on FTC Red Flag Rules

Amy Sorrel of AMNews wrote a recent article discussing the Red Flag Rules and the delayed enforcement: "New Federal Trade Commission regulations to combat identity theft have taken physicians and the health care industry by surprise and prompted the agency to delay enforcement from Nov. 1 to May 1, 2009."

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False Statement Within Claim Does Not Result In Liability Under FCA

Darci.Friedman — Tue, 28 Oct 2008 12:44:31 -0500

Effect of Untrue Certification of Compliance in Annual Cost Report

A provider's certification of compliance with Medicare statutes and regulations as stated in an annual cost report does not render all claims submitted for reimbursement by that provider false under the False Claims Act (FCA) if that statement is not true.

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The 2009 CPT Update Has Been Released!

Nicole.Stone — Thu, 23 Oct 2008 16:08:44 -0500

The January 1, 2009, CPT annual update has been released by the AMA. To avoid denied claims for improper coding beginning January 1st, all providers must implement this annual update over the next two months - not an easy thing to accomplish for any staff! To help, we've compiled the following summary to give you a sample of the larger procedural services that are changing.

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Necessary Documentation for E/M Codes

Jennifer.Ridell — Thu, 23 Oct 2008 15:21:33 -0500

The Health Care Compliance Association recently hosted a webinar related to coding evaluation and management (E/M) services provided in an outpatient facility.

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Can you define "child" for coding purposes?

Jennifer.Ridell — Thu, 23 Oct 2008 15:08:58 -0500

Recently a customer asked us what the definition of “child” is for coding purposes. Our own research on this topic has proven inconclusive so we wanted to put this out there to others in the field for consideration and feedback.

Let’s start by considering a general definition for child. When you think of the word "child" as a general term what is the true definition? Next, is there a specific catch-all definition for child or does it truly differ for a specific code or payment system?

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FTC Delays Identity Theft Prevention Program Compliance Deadline

Darci.Friedman — Wed, 22 Oct 2008 18:44:22 -0500

New Red Flag Compliance Deadline - May 1, 2009!

Just this afternoon, the FTC announced that it would delay the deadline to comply with the new Red Flag Rules from November 1, 2008 to May 1, 2009. The delay is to due to the confusion and uncertainty created in certain industries over whether the rules apply to them. "Many entities also noted that because they generally are not required to comply with FTC rules in other contexts, they had not followed or even been aware of the rulemaking, and therefore learned of the requirements of

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Profit/Nonprofit Hospitals Provide Similar Charity Care

Darci.Friedman — Wed, 15 Oct 2008 09:50:02 -0500

IRS Authority to Question Nonprofit Hospitals About Charity Care

“We don’t see much of a difference between nonprofit hospitals and for-profit hospitals,” said Theresa Pattara, a staff member of the office of Senate Finance Committee (SFC) ranking member Charles E. Grassley (R-Iowa), at an American Health Lawyers Association program on September 12 in Washington D.C.

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ICD-10: The New Standard in Coding

Nicole.Stone — Tue, 07 Oct 2008 19:27:17 -0500

CMS Proposes Adopting ICD-10 Codes as Standard

The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) have been proposed to be concurrently adopted as the standard code sets for coding diagnoses and inpatient hospital procedures, respectively.

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FTC Red Flag Rules Alert!

Darci.Friedman — Tue, 07 Oct 2008 11:51:00 -0500

MediRegs Resources on the FTC Red Flag Rules

New rules take effect November 1, 2008 that may require health care providers to develop and implement a written identity theft prevention program. Health care providers can be "creditors" under the broad definition set forth in the rules. Indeed, health care entities are specifically mentioned in the Federal Register article promulgating the rules. Red Flags are a pattern, practice, or specific activity that could indicate identity theft. To help you identify whether these rules apply to yo

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CMS announces new recovery audit contractors

Paul.Clark — Tue, 07 Oct 2008 11:06:52 -0500

On October 6, 2008, CMS announced the names of the new national recovery audit contractors (RACs). The new RACs are:

Diversified Collection Services, Inc. of Livermore, California, in Region A, initially working in Maine, New Hampshire, Vermont, Massachusetts, Rhode Island and New York.

CGI Technologies and Solutions, Inc. of Fairfax, Virginia, in Region B, initially working in Michigan, Indiana and Minnesota.

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Attention District of Columbia, Maryland, New Jersey and Pennsylvania LCD users…..MAC J12 Part A LCD’s are here!!

admin — Sun, 05 Oct 2008 21:42:01 -0500

Attention District of Columbia, Maryland, New Jersey and Pennsylvania LCD users…..MAC J12 Part A LCD’s have been posted on the MediRegs Regulation and Reimbursement Suite site as of today (10/03/08). Please see your state library or the LCD library to view the new MAC J12 Part A LCD’s today!

Effective Dates and Grace Periods for New Codes

Rayellen.Gilles — Fri, 03 Oct 2008 12:30:00 -0500

A smart user has asked: “Our system does not have the new codes effective 10/1/2008 loaded yet. Can I still use the old codes?”

The short answer is: there is NO grace period.

WK strives to deliver coding content as quickly as possible, and certainly before the effective date. Generally, content is posted to ChargeMaster comply within 48 hours, and to the coding tools and codebooks within a week. This can be difficult when CMS publishes data late. Please feel free to e-mail with any questions!!

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MAC J12 Part A LCDs added to Regulation and Reimbursement Suite

Fri, 03 Oct 2008 12:30:00 -0500

Attention District of Columbia, Maryland, New Jersey and Pennsylvania LCD users…..MAC J12 Part A LCD’s are here!!

Attention District of Columbia, Maryland, New Jersey and Pennsylvania LCD users…..MAC J12 Part A LCD’s have been posted on the MediRegs Regulation and Reimbursement Suite site as of today (10/03/08). Please see your state library or the LCD library to view the new MAC J12 Part A LCD’s today!

Medically Unlikely Edits (MUE)

Rayellen.Gilles — Thu, 02 Oct 2008 09:52:00 -0500

2011 Update: Medicaid MUEs are now included, so there are 6 different MUE tables. To get to this info, you have 2 choices, browse or search.

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CCH Medicare and Medicaid Guide- September 2008

Jonathan.Schwartz — Mon, 15 Sep 2008 12:18:00 -0500

Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) (PubLNo 110-275)

The Social Security Act sections related to the Medicare and Medicaid programs, as published in the CCH Medicare and Medicaid Guide, have been updated to reflect the “Medicare Improvements for Patients and Providers Act of 2008” (MIPPA) (PubLNo 110-275). The law section now includes revisions of existing law, the addition of new sections enacted by MIPPA, and updated amendment notes and histories.

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Health care compliance-Latest Information

Jonathan.Schwartz — Mon, 15 Sep 2008 11:58:00 -0500

Health Care Compliance Letter

Volume 11-16, August 5, 2008

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Reimbursement for Re-Processing "Single-Use" Devices

Rayellen.Gilles — Tue, 09 Sep 2008 11:21:00 -0500

A smart user asked for help researching this subject, and I’d like to share what we found.

This was a fun one for me to research, as it illustrates the increasing complexity of compliance where FDA and CMS have joint jurisdiction. I think we’ve gotten off in the right direction with this research, but FEEDBACK FROM OUR COMMUNITY Click the “leave a comment link” will really help flesh out a solid understanding of this issue.

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Hospital APC Payment Tools

Rayellen.Gilles — Fri, 01 Aug 2008 14:17:00 -0500

A smart user who has access to both the CCH Reimbursement Toolkit Hospital Outpatient PPS Calculator and the MediRegs APC Grouper & Calculator in RRS/Plus has asked:
What is the difference between these 2 calculators?
I thought I’d share the summary with MediBloggers. Note that you’ll see reference here to the exciting new Coding & Audit Suites which will be available shortly.

There are 2 APC Calculators Available. Let me summarize them for you here:

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Coding Update- July 2008

Jonathan.Schwartz — Thu, 31 Jul 2008 15:42:00 -0500

Medicare Improvements for Patients and Providers Act of 2008

On July 15, 2008, the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) (PubLNo 110-275) was enacted. As a result of this new legislation many payment systems and other Medicare programs were immediately affected. Below is a brief summary of how different providers are affected by this new legislation.

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Reimbursement Integrated Library- July 2008

Jonathan.Schwartz — Mon, 07 Jul 2008 15:45:00 -0500

Reimbursement Integrated Library

Dennis Barry’s Reimbursement Advisor

Each month, Dennis Barry’s Reimbursement Advisor includes two or three articles the offer practicalanalysis on specific aspects of healthcare provider reimbursement. Thenewsletter is particularly helpful in explaining some of the more complex areasof Medicare reimbursement and regulation. A good example of this is the leadstory in the July 2008 issue on Medicare bad debt. The article explains how a

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ComplyTrack Changes

Tue, 01 Jul 2008 11:52:00 -0500

Catch the Latest ComplyTrack Wave -- What's New in 5.0 This Week

This week’s changes focused mostly on the Contract and Relationship Manager.

Some new fields were added

In Manage Representatives, a new field was added to record the effective date for each permission and review. We also added a field to record the representative’s birthday.

In the contract sub-agreement, a new field was added to record description and notes.

In the contract, we added a field to record the Owner.

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Health Care Compliance Update: June 2008

Jonathan.Schwartz — Tue, 17 Jun 2008 14:41:00 -0500

Health Care Compliance Update: June 2008

Hot Topics• Recovery Audit Contractors• Medicaid Enforcement• OIG’s revised self-disclosure requirements• Electronic medical records/Health information technology• Quality of care• Hospital acquired conditions or “Never events”

Health Care Compliance LetterVolume 11-10, May 13, 2008

Fraud and Abuse

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More MAC J1 LCD's added to MediRegs

Mon, 16 Jun 2008 12:00:00 -0500

MAC J1 LCDS for CA, Guam, HI, NV, American Samoa and North Marianna Islands

Attention American Samoa, California , Guam, Hawaii, Nevada and North Marianna Islands LCD users.....MAC J1 LCD's are here!!Attention American Samoa, California , Guam, Hawaii, Nevada and North Marianna Islands LCD users…..MAC J1 LCD’s have been posted on the MediRegs Regulation and Reimbursement Suite site as of today (6/16/08). Please see your state library or the LCD library to view the new MAC J1 LCD’s today!