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.

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.

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

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).

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. 

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.

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

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.

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.

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.