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.

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.
 

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?

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.

 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.

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.

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.

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.

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).

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