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.

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.

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.

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.”

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.

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).

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

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!

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.

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.