Stay current with the latest industry news along with coding, billing and reimbursement case studies and analyses. http://www.OptumCoding.com/CodingCircleArticles/ A unique health plan identifier (HPID) that is one of the administrative simplification provisions of the Affordable Care Act is the subject of a proposed rule published in the April 17, 2012, Federal Register. This rule would also implement a data element to apply as an “other entity” identifier (OEID) for entities needing to be identified in standard transactions that are not health plans, health care providers, or individuals. http://www.OptumCoding.com/CodingCircleArticles/?id=924 Fri, 27 Apr 2012 00:00:00 -0500 All of the rumors and speculation surrounding a delay in the date for compliance with ICD-10-CM and -PCS have finally been put to rest. In a proposed rule published in the April 17, 2012, Federal Register, the Department of Health and Human Services (HHS) announced its intention to delay compliance one year, from October 1, 2013, to October 1, 2014. http://www.OptumCoding.com/CodingCircleArticles/?id=925 Fri, 27 Apr 2012 00:00:00 -0500 The following table lists tests approved by the Food and Drug Administration as waived under the Clinical Laboratory Improvement Act (CLIA) effective July 1, 2012. Keep in mind that modifier QW must be appended to these codes for them to be recognized as CLIA-waived tests. http://www.OptumCoding.com/CodingCircleArticles/?id=926 Fri, 27 Apr 2012 00:00:00 -0500 Rather than having thousands of changes, as has been seen frequently in the past, the most recent update to the National Correct Coding Initiative (NCCI) edits, version 18.1, has just 400. The changes, effective April 1, 2012, include 362 new and 23 deleted edits, and 12 edit and three modifier revisions. http://www.OptumCoding.com/CodingCircleArticles/?id=921 Fri, 20 Apr 2012 00:00:00 -0500 The quarterly update to HCPCS Level II codes includes several additions, revisions, and deletions. It is important to note the effective date of each change, as they do vary. http://www.OptumCoding.com/CodingCircleArticles/?id=922 Fri, 20 Apr 2012 00:00:00 -0500 Both the number of health care professionals participating in the Physician Quality Reporting System (PQRS) and Electronic Prescribing (eRx) Incentive Program and the amount of incentives paid out under these programs have increased considerably, according to a recent report from the Centers for Medicare & Medicaid Services (CMS). Both programs paid a total of $662,531,035 in incentives in 2010, which represents an increase of 72-percent from the 2009 incentives of $384,704,248. http://www.OptumCoding.com/CodingCircleArticles/?id=923 Fri, 20 Apr 2012 00:00:00 -0500 The Centers for Medicare & Medicaid Services’ Office of E-Health Standards and Services (OESS) recently announced that it will not initiate enforcement actions against HIPAA-covered entities not compliant with Version 5010 transactions until June 30, 2012. This 90-day “grace period,” was established to provide a discretionary timeframe during which covered entities were allowed to complete pending 5010 implementation activities (e.g., software installation, testing). http://www.OptumCoding.com/CodingCircleArticles/?id=917 Thu, 05 Apr 2012 00:00:00 -0500 Physician practices might have noticed an uptick in visits for colorectal cancer screenings in March, which is National Colorectal Cancer (CRC) Awareness Month. http://www.OptumCoding.com/CodingCircleArticles/?id=918 Thu, 05 Apr 2012 00:00:00 -0500 The 2012 ICD-10-CM Draft Official Guidelines for Coding and Reporting contains updated advice for coding and reporting drug-induced (adverse-effect) conditions that aligns coding practice with ICD-9-CM. http://www.OptumCoding.com/CodingCircleArticles/?id=919 Thu, 05 Apr 2012 00:00:00 -0500 The 2012 ICD-10-CM Draft Official Guidelines for Coding and Reporting contains updated advice for coding and reporting drug-induced (adverse-effect) conditions that aligns coding practice with ICD-9-CM. http://www.OptumCoding.com/CodingCircleArticles/?id=920 Thu, 05 Apr 2012 00:00:00 -0500 Due to the partial code freeze, the March 5, 2012, ICD-9-CM Coordination and Maintenance Committee Meeting at the headquarters of the Centers for Medicare and Medicaid Services in Baltimore was brief, adjourning before 12:30 p.m. http://www.OptumCoding.com/CodingCircleArticles/?id=914 Wed, 21 Mar 2012 00:00:00 -0500 On February 16, 2012, Health and Human Services Secretary Kathleen G. Sebelius announced that HHS will initiate a process to postpone the date by which "certain health care entities" would have to comply with the implementation of the ICD-10 classification system for reporting diagnoses and (inpatient hospital) procedures. http://www.OptumCoding.com/CodingCircleArticles/?id=915 Wed, 21 Mar 2012 00:00:00 -0500 At the meeting of the ICD-9-CM Coordination and Maintenance Committee March 5, 2012, at the headquarters of the Centers for Medicare and Medicaid Services in Baltimore, attendees reviewed the following ICD-10 Medicare severity diagnosis-related group (MS-DRG) topics. http://www.OptumCoding.com/CodingCircleArticles/?id=916 Wed, 21 Mar 2012 00:00:00 -0500 The Affordable Care Act saved 3.6 million people with Medicare $2.1 billion on their prescription drugs in 2011, according to a report released February 2 by the Department of Health and Human Services. http://www.OptumCoding.com/CodingCircleArticles/?id=913 Thu, 01 Mar 2012 00:00:00 -0600 The erroneous claims a recovery audit contractor recently discovered suggest that ambulance service providers and hospitals could use a refresher on billing guidelines. http://www.OptumCoding.com/CodingCircleArticles/?id=911 Thu, 01 Mar 2012 00:00:00 -0600 Although the White House acknowledged in 2010 that a nuclear attack by terrorists was the most urgent danger to the United States, few localities have meaningful plans to handle all aspects of a non-power plant radiological or nuclear incident, according to the Office of Inspector General. The Department of Homeland Security estimates that such planning could save tens of thousands of lives. http://www.OptumCoding.com/CodingCircleArticles/?id=912 Thu, 01 Mar 2012 00:00:00 -0600 Several new screening and counseling services provided in the primary care setting are now covered by Medicare, thanks to a focus on preventive services as a way to reduce health care costs. http://www.OptumCoding.com/CodingCircleArticles/?id=908 Thu, 16 Feb 2012 00:00:00 -0600 The Centers for Medicare and Medicaid Services has issued corrections and changes to the HCPCS code set since it was first posted last November. Because new, deleted, and revised codes can mean the difference between payment and denial, it is important to keep up on such changes. http://www.OptumCoding.com/CodingCircleArticles/?id=909 Thu, 16 Feb 2012 00:00:00 -0600 Intensive behavioral therapy for cardiovascular disease in a primary care setting is covered by Medicare, effective November 8, 2011. http://www.OptumCoding.com/CodingCircleArticles/?id=910 Thu, 16 Feb 2012 00:00:00 -0600 Accountable care organizations (ACO) will be happy to learn that changes in the final rule on the Medicare Shared Savings Program for ACOs were crafted to encourage participation and give ACOs time to acclimate themselves to the program before having to take on too much risk. http://www.OptumCoding.com/CodingCircleArticles/?id=905 Fri, 03 Feb 2012 00:00:00 -0600 One of the key modifications the Centers for Medicare and Medicaid Services made in the final rule for the Medicare Shared Savings Program was to ease participation requirements for rural providers. http://www.OptumCoding.com/CodingCircleArticles/?id=906 Fri, 03 Feb 2012 00:00:00 -0600 Criminal background checks do not significantly reduce the number of applicants for jobs involving direct access to long-term care (LTC) patients, a study by the Office of Inspector General reveals. http://www.OptumCoding.com/CodingCircleArticles/?id=907 Fri, 03 Feb 2012 00:00:00 -0600 CPT codes for skin replacement have changed significantly for 2012. Eight new codes were added (CPT codes 15271–15278) in the integumentary section under the subsection “Skin Substitutes Grafts” to replace 32 deleted codes (15170–15431) that defined the specific type of skin substitute. http://www.OptumCoding.com/CodingCircleArticles/?id=902 Wed, 25 Jan 2012 00:00:00 -0600 Beginning in 2012, the insertion and removal of contraception capsules are to be reported separately rather than with one combination code. http://www.OptumCoding.com/CodingCircleArticles/?id=903 Wed, 25 Jan 2012 00:00:00 -0600 An interim final rule published in the Federal Register January 10, 2012, describes two standards health plans must comply with to use electronic funds transfers (EFT) to transmit health care claim payments to providers. One of the regulations defines the standard format health plans must use when ordering, authorizing, or initiating an EFT with their financial institutions, and the other outlines the data the EFT must contain. http://www.OptumCoding.com/CodingCircleArticles/?id=904 Wed, 25 Jan 2012 00:00:00 -0600 Effective January 1, 2012, the three-day payment window for outpatient services provided within 72 hours of an inpatient admission applies to both diagnostic and nondiagnostic services. The Centers for Medicare and Medicaid Services (CMS) is allowing entities a six-month grace period to coordinate their billing and claims processing procedures to ensure full compliance for claims received on or after July 1, 2012. http://www.OptumCoding.com/CodingCircleArticles/?id=897 Thu, 19 Jan 2012 00:00:00 -0600 The Washington Publishing Company (WPC) has once again released its claim adjustment reason codes (CARC) and remittance advice remark codes (RARC) update effective March 1, 2012. Code set changes generally include new, modified, and deactivated codes. http://www.OptumCoding.com/CodingCircleArticles/?id=898 Thu, 19 Jan 2012 00:00:00 -0600 Physicians, clinical diagnostic laboratories, and other providers who provide services to Medicare beneficiaries should note that the multiple procedure payment reduction (MPPR) has been expanded to include the professional component (PC), in addition to the technical component (TC), of certain diagnostic imaging procedures. http://www.OptumCoding.com/CodingCircleArticles/?id=901 Thu, 19 Jan 2012 00:00:00 -0600 The negative update under current law for the 2012 Medicare Physician Fee Schedule was scheduled to take effect on January 1, 2012. http://www.OptumCoding.com/CodingCircleArticles/?id=896 Fri, 06 Jan 2012 00:00:00 -0600 The final rule updating payment policies and rates for services provided in hospital outpatient departments and ambulatory surgery centers (ASCs) was released by the Centers for Medicare and Medicaid Services (CMS) on November 1, 2011. http://www.OptumCoding.com/CodingCircleArticles/?id=830 Wed, 21 Dec 2011 00:00:00 -0600 What had been a January 2, 2012, deadline to comply with the transaction standards in the Health Insurance Portability and Accountability Act has been pushed to March 31, 2012, because of reports that many entities would not be ready by the new year. http://www.OptumCoding.com/CodingCircleArticles/?id=831 Wed, 21 Dec 2011 00:00:00 -0600 Earlier this month, the Centers for Medicare and Medicaid Services (CMS) released a final regulation requiring health insurance companies to spend a minimum of 80 percent of patient premiums on medical care as opposed to spending it on income, overhead, or marketing. Companies that fail to meet this requirement must issue a rebate to consumers. http://www.OptumCoding.com/CodingCircleArticles/?id=832 Wed, 21 Dec 2011 00:00:00 -0600 Among the provisions in the final rule for the Medicare physician fee schedule for 2012 released on November 1, 2011, are significant reductions in provider payment rates for the upcoming federal fiscal year—to the tune of 27.4 percent, unless Congress intervenes. All changes are slated to take effect January 1, 2012. http://www.OptumCoding.com/CodingCircleArticles/?id=827 Tue, 06 Dec 2011 00:00:00 -0600 On November 29, the Centers for Medicare and Medicaid Services (CMS) announced that it will cover preventive services aimed at reducing obesity. This new benefit will be available without any cost sharing, as with other Medicare preventive services under the Affordable Care Act. http://www.OptumCoding.com/CodingCircleArticles/?id=828 Tue, 06 Dec 2011 00:00:00 -0600 The final rule on physician payment released on November 1, 2011, includes an expansion of the incentive programs associated with Medicare physician fee schedule (MPFS) payments to include electronic health records (EHRs) and the Physician Quality Reporting System (PQRS), and clarifies the Physician Compare tool. http://www.OptumCoding.com/CodingCircleArticles/?id=829 Tue, 06 Dec 2011 00:00:00 -0600 Nineteen new procedure codes were added to ICD-9-CM volume 3 effective October 1, 2011, with multiple revised procedure titles, inclusion terms, and exclusions. http://www.OptumCoding.com/CodingCircleArticles/?id=895 Thu, 06 Oct 2011 00:00:00 -0500 The addition of more than 160 new ICD-9-CM diagnosis codes effective October 1, 2011, marks the last regular annual update to the ICD-9-CM code set before the partial code freeze. Next year, on October 1, 2012, only limited code updates will be made to ICD-9-CM, pending the transition to ICD-10-CM/PCS on October 1, 2013. http://www.OptumCoding.com/CodingCircleArticles/?id=825 Thu, 06 Oct 2011 00:00:00 -0500 The Centers for Medicare and Medicaid Services recently released revisions to the ICD-10-PCS for 2012. A total of 1,182 new procedure codes were added, 1,345 codes were deleted, and 381 code titles were revised, resulting in a 2012 total of 71,918 ICD-10-PCS codes. ICD-10-PCS will replace ICD-9-CM, volume 3, effective October 1, 2013. http://www.OptumCoding.com/CodingCircleArticles/?id=826 Thu, 06 Oct 2011 00:00:00 -0500 In the proposed Medicare physician fee schedule rule released in the Federal Register on July 19, 2011, several additional services were recommended for inclusion as covered telehealth services for 2012, including: http://www.OptumCoding.com/CodingCircleArticles/?id=892 Tue, 16 Aug 2011 00:00:00 -0500 Medicare provides a comprehensive hospice care benefit for beneficiaries with a terminal illness and a life expectancy of six months or less. However, a recent Office of Inspector General (OIG) report demonstrated the evidence of fraud, abuse, and waste in this benefit. http://www.OptumCoding.com/CodingCircleArticles/?id=893 Tue, 16 Aug 2011 00:00:00 -0500 Revisions brought about by the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 now make it possible for Medicare beneficiaries who need help paying for prescription drugs to qualify for the Medicare Low-Income Subsidy Program (LIS or “Extra Help”). http://www.OptumCoding.com/CodingCircleArticles/?id=894 Tue, 16 Aug 2011 00:00:00 -0500 A new therapy has been approved for payment by the Centers for Medicare and Medicaid Services that specifically targets castration-resistant, metastatic prostate cancer. New treatments for this type of cancer are particularly welcome since the median survival after diagnosis is usually less than two years. http://www.OptumCoding.com/CodingCircleArticles/?id=889 Tue, 02 Aug 2011 00:00:00 -0500 Each quarter the laboratory edit module is updated to reflect any coding updates and changes to Medicare national coverage determinations http://www.OptumCoding.com/CodingCircleArticles/?id=890 Tue, 02 Aug 2011 00:00:00 -0500 Since January 1, 2009, Medicare’s coverage of HIV screening as an "additional preventive service" has undergone several updates, with the latest relevant transmittal being released in April 2011. http://www.OptumCoding.com/CodingCircleArticles/?id=891 Tue, 02 Aug 2011 00:00:00 -0500 Cancer hospitals are particularly affected by this year’s proposed rule updating Medicare payment for hospital outpatient departments for calendar year 2012. The rule proposes applying a payment adjustment to each hospital’s outpatient prospective payments for a projected total of 9 percent, although some hospitals will receive a 0 percent adjustment. http://www.OptumCoding.com/CodingCircleArticles/?id=886 Mon, 18 Jul 2011 00:00:00 -0500 Those who receive both Medicare and Medicaid benefits (dual eligibles) are the focus of states’ new care models designed to improve the way they get health care. http://www.OptumCoding.com/CodingCircleArticles/?id=887 Mon, 18 Jul 2011 00:00:00 -0500 Because an expected shift in the balance of therapy services billed by skilled nursing facilities did not occur in 2011, Medicare ended up paying $2.1 billion more than expected. The shift was expected because of various changes in how the Centers for Medicare & Medicaid Services pays for SNF services. http://www.OptumCoding.com/CodingCircleArticles/?id=888 Mon, 18 Jul 2011 00:00:00 -0500 The Centers for Medicare and Medicaid Services (CMS) has changed its current policy barring the billing of observation services with diagnostic or therapeutic services involving active monitoring (for example, colonoscopy or chemotherapy) to accommodate situations in which such a procedure interrupts observation services. Hospitals may report observation hours for the services that are not related to the procedure monitoring. http://www.OptumCoding.com/CodingCircleArticles/?id=883 Wed, 13 Jul 2011 00:00:00 -0500 The Centers for Medicare and Medicaid Services (CMS) is proposing to retract its new requirement that all requisitions for clinical diagnostic laboratory tests paid under the clinical laboratory fee schedule (CLFS) include a physician’s or qualified nonphysician practitioner’s (NPP) signature. http://www.OptumCoding.com/CodingCircleArticles/?id=884 Wed, 13 Jul 2011 00:00:00 -0500 The proposed rule for physician payment under Medicare in calendar year 2012, aside from putting forth yet another payment reduction that may or may not be reversed by Congress, expands the number of misvalued codes and adjusts payment for geographic variation in practice costs. The rule also takes steps to implement some of the stipulations in the Affordable Care Act. http://www.OptumCoding.com/CodingCircleArticles/?id=885 Wed, 13 Jul 2011 00:00:00 -0500 A recently released proposed rule would allow eligible providers to get an exemption from the 2012 ePrescribing payment adjustment if they have a significant hardship. http://www.OptumCoding.com/CodingCircleArticles/?id=880 Tue, 07 Jun 2011 00:00:00 -0500 People will be able to obtain a report on who has electronically accessed their protected health information (PHI) if a proposed rule published by the Department of Health and Human Services (HHS) Office for Civil Rights (OCR) is finalized. http://www.OptumCoding.com/CodingCircleArticles/?id=881 Tue, 07 Jun 2011 00:00:00 -0500 Health care consumers will be able to get a complete picture of providers’ and suppliers’ quality of care and costs if a recently published proposed rule is finalized. The rule would allow qualified organizations to publicize health care quality and cost information compiled from multiple sources, a vast improvement over current, piecemeal releases of such information. http://www.OptumCoding.com/CodingCircleArticles/?id=882 Tue, 07 Jun 2011 00:00:00 -0500 The Centers for Medicare and Medicaid Services (CMS) estimates that its proposed changes to the inpatient prospective payment system (IPPS) for fiscal 2012 would affect 3,400 acute care hospitals and 420 long-term care hospitals (LTCH). The agency is projecting that the proposed changes, which include a hospital update of 1.5 percent, would result in a payment reduction of 0.5 percent, or $498 million. http://www.OptumCoding.com/CodingCircleArticles/?id=877 Wed, 18 May 2011 00:00:00 -0500 Misplaced incentives and inequalities in physician reimbursement are discussed at length in the Medicare Payment Advisory Commission’s (MedPAC) latest report to congress. The report, released March 2011, analyzes the methodology of sustainable growth rate (SGR) used to determine physician reimbursement. http://www.OptumCoding.com/CodingCircleArticles/?id=878 Wed, 18 May 2011 00:00:00 -0500 A report released by the Office of Inspector General (OIG) found significant errors in the reporting of imaging services performed on Medicare beneficiaries in the emergency department during 2008. These failures to meet guidelines for reimbursement are thought to persist today. http://www.OptumCoding.com/CodingCircleArticles/?id=879 Wed, 18 May 2011 00:00:00 -0500 Eligible providers must be eprescribing by June 30, 2011, or face a 1 percent negative payment adjustment beginning January 1, 2012, as stipulated by the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008. The Centers for Medicare and Medicaid Services (CMS) will use the claims data for the period January 1 through June 30, 2011, to determine who gets the payment adjustment beginning January 1 http://www.OptumCoding.com/CodingCircleArticles/?id=874 Wed, 13 Apr 2011 00:00:00 -0500 As of January 1, 2011, patients who receive preventive services in a rural health center (RHC) or federally qualified health center (FQHC) do not have to pay a deductible or coinsurance for those services. http://www.OptumCoding.com/CodingCircleArticles/?id=875 Wed, 13 Apr 2011 00:00:00 -0500 If a new proposal is adopted, accountable care organizations (ACOs) could share in the financial benefits the Medicare program would receive through better coordination of patient care. http://www.OptumCoding.com/CodingCircleArticles/?id=876 Wed, 13 Apr 2011 00:00:00 -0500 A proposed disclosure form for health insurance rate increases over a certain threshold aims to prevent consumers from being blindsided by rate hikes. http://www.OptumCoding.com/CodingCircleArticles/?id=871 Fri, 01 Apr 2011 00:00:00 -0500 Confusion over something called the “maintenance-of-effort” rules as they relate to the Affordable Care Act prompted the Department of Health and Human Services to release a letter to state Medicaid directors February 25 clarifying the rules. http://www.OptumCoding.com/CodingCircleArticles/?id=872 Fri, 01 Apr 2011 00:00:00 -0500 A new $100 million program enables states to provide various incentives, financial and otherwise, to Medicaid beneficiaries in an effort to improve personal health and decrease chronic health conditions in the long term. http://www.OptumCoding.com/CodingCircleArticles/?id=873 Fri, 01 Apr 2011 00:00:00 -0500 The Centers for Medicare and Medicaid Services (CMS) has provided instructions to all contractors describing how claims history data should be used when examining Medicare claims during a medical review. http://www.OptumCoding.com/CodingCircleArticles/?id=868 Fri, 18 Mar 2011 00:00:00 -0500 Providers will be happy to know that the changes in the most recent update to the Medicare physician fee schedule database (MPFSDB) are very minor. http://www.OptumCoding.com/CodingCircleArticles/?id=869 Fri, 18 Mar 2011 00:00:00 -0500 A recent transmittal to Medicare contractors explains what ICD-9-CM codes are related disorders to Alzheimer’s disease. This is important since the treatment of the disease is NOT subject to an outpatient payment limit. http://www.OptumCoding.com/CodingCircleArticles/?id=870 Fri, 18 Mar 2011 00:00:00 -0500 Feedback from recovery audit contractors (RAC), physicians, and physician associations has prompted the Centers for Medicare and Medicaid Services (CMS) to modify the number of additional documentation request (ADR) limits that RACs can make. http://www.OptumCoding.com/CodingCircleArticles/?id=865 Wed, 02 Mar 2011 00:00:00 -0600 The Centers for Medicare and Medicaid Services (CMS) recently released a proposed new rule to require Medicare participating providers and suppliers to give beneficiaries written notice of their right to contact a Medicare quality improve organization (QIO) when concerns arise regarding the quality of care received under the Medicare program. http://www.OptumCoding.com/CodingCircleArticles/?id=866 Wed, 02 Mar 2011 00:00:00 -0600 The Office of Actuary report released in early January 2011 indicated that U.S. health care spending had one of the slowest growth rates in the 50-year history of the National Health Expenditure Accounts (NHEA). The report found that spending grew 4 percent in fiscal 2009, down from 4.7 percent in 2008, the second slowest rate of growth in the NHEA’s history. This was attributed to slower growth in private health insurance expenditures and consumer out-of-pocket spending, and a reduction in capital investments. http://www.OptumCoding.com/CodingCircleArticles/?id=867 Wed, 02 Mar 2011 00:00:00 -0600 Providers are running into snags with the recent roll-out of Medicare coverage for annual wellness visits with personalized prevention plan services. http://www.OptumCoding.com/CodingCircleArticles/?id=862 Fri, 11 Feb 2011 00:00:00 -0600 The Centers for Medicare and Medicaid Services (CMS) recently released changes in the durable medical equipment (DME) fee schedule, updates to reimbursement for DME repair, wheelchairs, and stationary oxygen, and new DME codes. http://www.OptumCoding.com/CodingCircleArticles/?id=863 Fri, 11 Feb 2011 00:00:00 -0600 The Medicare administrative contractors (MAC) for Kentucky and Ohio are changing in 2011. Additionally, the home health and hospice MAC will change from region B to jurisdiction 13. http://www.OptumCoding.com/CodingCircleArticles/?id=864 Fri, 11 Feb 2011 00:00:00 -0600 As of January 1, the nearly 130 million nonelderly Americans with pre-existing conditions who could be denied health care coverage by private insurance companies will have another insurance option. As part of the Affordable Care Act (ACA), the Pre-Existing Condition Plan (PCIP) makes health insurance available to people who had been denied coverage by private insurance companies because of a pre-existing condition. http://www.OptumCoding.com/CodingCircleArticles/?id=859 Fri, 04 Feb 2011 00:00:00 -0600 As part of the Affordable Care Act (ACA), a provider certifying a patient’s eligibility for the home health benefit must document that he or she, or an allowed nonphysician practitioner (NPP), has had a face-to-face encounter with the patient. http://www.OptumCoding.com/CodingCircleArticles/?id=860 Fri, 04 Feb 2011 00:00:00 -0600 Beginning July 1 the Centers for Medicare and Medicaid Services (CMS) will recognize two new physician specialty codes: (21) cardiac electrophysiology and (23) sports medicine. Physicians self-designate their Medicare specialty on either the Medicare enrollment application or via the internet-based, Provider Enrollment, Chain and Ownership System (PECOS), when they enroll in the Medicare program. http://www.OptumCoding.com/CodingCircleArticles/?id=861 Fri, 04 Feb 2011 00:00:00 -0600 Although section 101 of the Medicare and Medicaid Extenders Act provided a 0 percent update to the conversion factor, providers should note that due to other factors, the conversion factor has actually been reduced to 33.9764, lower than the 2010 conversion factor. http://www.OptumCoding.com/CodingCircleArticles/?id=857 Mon, 10 Jan 2011 00:00:00 -0600 Beginning January 12, the Centers for Medicare and Medicaid Services (CMS) will require that any Medicare contractor, including Medicare administrative contractors (MACs) and recovery audit contractors (RACs), request the advance beneficiary notice (ABN) as part of the additional documentation requests (ADR) when performing complex medical reviews (CMRs). http://www.OptumCoding.com/CodingCircleArticles/?id=858 Mon, 10 Jan 2011 00:00:00 -0600 Registration began for the Electronic Health Record Incentive program January 3, 2011. Providers interested in participating must register before they have a certified HER; according to the Centers for Medicare and Medicaid Services (CMS), providers should register even if they do not have an enrollment record in the Provider Enrollment, Chain, and Ownership System (PECOS). http://www.OptumCoding.com/CodingCircleArticles/?id=851 Mon, 10 Jan 2011 00:00:00 -0600 As required by the Affordable Care Act (ACA), Medicare will cover an annual wellness visit (AWV) with personalized prevention plan effective January 1. However, before billing for the service, providers must know what specific requirements must be met. http://www.OptumCoding.com/CodingCircleArticles/?id=852 Thu, 23 Dec 2010 00:00:00 -0600 Providers need to remember that the deadline for submitting claims for dates of service Oct. 1 through December 31, 2009, is right around the corner. If you have Medicare fee-for-service claims with service dates from this time period, those claims MUST be filed by Dec. 31, 2010, or Medicare will deny them. http://www.OptumCoding.com/CodingCircleArticles/?id=853 Thu, 23 Dec 2010 00:00:00 -0600 During the November 2011 CPT Symposium, the American Medical Association announced the creation of a new modifier that is not included in the 2011 CPT manual. Modifier 33 Preventive Service, is related to mandated preventive services performed in order to comply with the Patient Protection and Affordable Care Act (see "Increased Access to Preventive Services Under the Affordable Care Act," July 2010). http://www.OptumCoding.com/CodingCircleArticles/?id=848 Mon, 06 Dec 2010 00:00:00 -0600 The American Medical Association has released three new E/M codes for subsequent observation care for use beginning January 1, 2011. http://www.OptumCoding.com/CodingCircleArticles/?id=849 Mon, 06 Dec 2010 00:00:00 -0600 The American Medical Association has released two new pediatric immunization administration codes for use beginning January 1, 2011. http://www.OptumCoding.com/CodingCircleArticles/?id=850 Mon, 06 Dec 2010 00:00:00 -0600 The Physician Payment and Therapy Relief Act extends the current physician fee schedule conversion factor of $36.8729 until December 31, 2010. Without this bill, providers would have endured a 23 percent cut in reimbursement. However, providers are still facing a possible 30 percent decrease in the conversion factor for 2011 if Congress does not take additional action. http://www.OptumCoding.com/CodingCircleArticles/?id=854 Fri, 26 Nov 2010 00:00:00 -0600 New codes effective in 2011 will allow specific reporting of brand-name flu vaccines. http://www.OptumCoding.com/CodingCircleArticles/?id=855 Fri, 26 Nov 2010 00:00:00 -0600 Effective April 1, 2011, the Centers for Medicare and Medicaid Services (CMS) is adding two new physician specialty codes: Cardiac electrophysiology will be identified with code 21, and sports medicine will be assigned code 23. http://www.OptumCoding.com/CodingCircleArticles/?id=856 Fri, 26 Nov 2010 00:00:00 -0600 Providers can expect a reduction in Medicare payment of more than 30 percent in 2011 unless Congress grants a reprieve. In the Medicare physician fee schedule (MPFS) final rule that the Centers for Medicare and Medicaid Services has placed on display, providers paid under the MPFS are looking at a 2011 conversion factor of $25.5217, effective January 1, 2011. The current conversion factor is $36.8729. http://www.OptumCoding.com/CodingCircleArticles/?id=845 Fri, 12 Nov 2010 00:00:00 -0600 The Centers for Medicare and Medicaid Services has posted the 2011 HCPCS Level II code set to its website. This code set is used primarily to report supplies but also contains codes for specific procedures and services that are not described by or cannot be reported using a CPT code. Level II codes are a designated code set under the Health Insurance Portability and Accountability Act (HIPAA). http://www.OptumCoding.com/CodingCircleArticles/?id=846 Fri, 12 Nov 2010 00:00:00 -0600 Physicians will find it easier in 2011 to qualify for incentive payments under the Physician Quality Reporting System (formerly the Physician Quality Reporting Initiative, or PQRI). The flip side is that the incentive payments will be lower than they are currently. http://www.OptumCoding.com/CodingCircleArticles/?id=847 Fri, 12 Nov 2010 00:00:00 -0600 On September 30, the Centers for Medicare and Medicaid Services (CMS) released a number of transmittals outlining coverage policies and reporting requirements for counseling services related to preventing tobacco use. http://www.OptumCoding.com/CodingCircleArticles/?id=842 Fri, 29 Oct 2010 00:00:00 -0500 OIG Releases Fiscal 2011 Work Plan Carefully reviewing the fiscal 2011 work plan the Office of Inspector General released October 1 can help physicians identify potential compliance risks for their provider type. http://www.OptumCoding.com/CodingCircleArticles/?id=843 Fri, 29 Oct 2010 00:00:00 -0500 The National Uniform Claim Committee’s semi-annual update to health care provider taxonomy codes were effective October 1, 2010. The update includes new codes, revisions to existing codes, and the addition of definitions to current codes. http://www.OptumCoding.com/CodingCircleArticles/?id=844 Fri, 29 Oct 2010 00:00:00 -0500 The Centers for Medicare and Medicaid Services has recently released version 16.3 of the Comprehensive Code Initiative (CCI) edits. These edits become effective October 1. http://www.OptumCoding.com/CodingCircleArticles/?id=839 Fri, 03 Sep 2010 00:00:00 -0500 Complex medical reviews of physician issues by recovery audit contractors had not begun as of September 2010 the Centers for Medicare and Medicaid Services had not yet authorized recovery audit contactors (RACs) to begin complex medical reviews of physician issues. http://www.OptumCoding.com/CodingCircleArticles/?id=840 Fri, 03 Sep 2010 00:00:00 -0500 The Centers for Medicare and Medicaid Services is expanding claim editing to verify that the attending, operating, or other physician or nonphysician practitioner rendering services to patients in a critical access hospital (CAH) is eligible and enrolled in Medicare. Toward this end, the agency will allow the Fiscal Intermediary Shared System (FISS) to match data on a provider’s claim to the national Provider Enrollment, Chain and Ownership System (PECOS) file. http://www.OptumCoding.com/CodingCircleArticles/?id=841 Fri, 03 Sep 2010 00:00:00 -0500 A recent Medicare transmittal clarifies that when the place of service code is 12, Home, the patient’s home address must be reported. http://www.OptumCoding.com/CodingCircleArticles/?id=836 Thu, 02 Sep 2010 00:00:00 -0500 Chiropractic claims will be reviewed as one of the Medicare high-risk areas targeted as a result of Executive Order 13520, Reducing Improper Payments and Eliminating Waste in Federal Programs. http://www.OptumCoding.com/CodingCircleArticles/?id=837 Thu, 02 Sep 2010 00:00:00 -0500 The World Health Organization (WHO) announced that the H1N1 pandemic is over. However, before you breathe that sigh of relief, it also stated that there are still cases of H1N1. http://www.OptumCoding.com/CodingCircleArticles/?id=838 Thu, 02 Sep 2010 00:00:00 -0500 Hospital outpatient departments could see a Medicare payment increase of 2.4 percent in calendar year 2011 if proposed rates become final. http://www.OptumCoding.com/CodingCircleArticles/?id=822 Mon, 16 Aug 2010 00:00:00 -0500 For calendar year 2011, the Centers for Medicare and Medicaid Services (CMS) is proposing somewhat of a compromise in the supervision policy for therapeutic services that will apply to all hospitals, including critical access hospitals (CAHs). http://www.OptumCoding.com/CodingCircleArticles/?id=834 Mon, 16 Aug 2010 00:00:00 -0500 For calendar year 2011, the Centers for Medicare and Medicaid Services is proposing to set different payment rates for partial hospitalization programs (PHPs) in community mental health centers and hospital outpatient departments. http://www.OptumCoding.com/CodingCircleArticles/?id=835 Mon, 16 Aug 2010 00:00:00 -0500 The Centers for Medicare and Medicaid Services (CMS) has released its proposed changes to the Physician Quality Reporting Initiative for 2011. http://www.OptumCoding.com/CodingCircleArticles/?id=823 Thu, 15 Jul 2010 00:00:00 -0500 Congress finally passed legislation signed into law by President Obama that not only prevents physicians from receiving a 21.3 percent payment reduction but actually establishes a 2.2 percent payment increase. http://www.OptumCoding.com/CodingCircleArticles/?id=824 Thu, 15 Jul 2010 00:00:00 -0500 It’s that time of year once again—providers are gearing up to make the necessary changes to codes submitted on medical claims. Up first are changes to the ICD-9-CM coding system. The ICD-9-CM Coordination and Maintenance Committee has approved revisions to the ICD-9-CM code set that are effective October 1, 2010. These codes were published in the Federal Register dated May 4, 2010, and CMS-1498-P, tables 6A-6F, and the official ICD-9-CM addenda effective October 1, 2010. http://www.OptumCoding.com/CodingCircleArticles/?id=819 Fri, 18 Jun 2010 00:00:00 -0500 Payers and providers could save hundreds of billions of dollars by centralizing and standardizing cumbersome and time-consuming administrative and medical tasks. It is with these enormous savings in mind that the Blue Cross and Blue Shield Association (BCBSA), in conjunction with America’s Health Insurance Plans (AHIP), has launched an initiative involving regional and statewide plans. The insurers will evaluate options enabling physicians to access multiple insurers through one universal information channel (i.e., web portal) in a specific area of the country. http://www.OptumCoding.com/CodingCircleArticles/?id=820 Fri, 18 Jun 2010 00:00:00 -0500 The Centers for Medicare and Medicaid Services (CMS) has determined that pulmonary rehabilitation programs are covered and payable as of January 1, 2010, when certain beneficiary and program requirements are met. http://www.OptumCoding.com/CodingCircleArticles/?id=821 Fri, 18 Jun 2010 00:00:00 -0500 This is proving to be a challenging year for physicians due to delays in implementing concrete legislative revisions to the Medicare physician fee schedule that would prevent payment cuts and alleviate uncertainty as to future reimbursement. http://www.OptumCoding.com/CodingCircleArticles/?id=816 Thu, 10 Jun 2010 00:00:00 -0500 The American Medical Association (AMA), in conjunction with the American Osteopathic Association (AOA) and the Medical Society of the District of Columbia, has filed a suit in federal court seeking to block the Federal Trade Commission (FTC) from imposing the “red flag” rule on physicians. http://www.OptumCoding.com/CodingCircleArticles/?id=817 Thu, 10 Jun 2010 00:00:00 -0500 The Centers for Medicare and Medicaid Services (CMS) released the latest revision to the HCPCS Level II coding system on May 21. http://www.OptumCoding.com/CodingCircleArticles/?id=818 Thu, 10 Jun 2010 00:00:00 -0500 On May 10, 2010, the Centers for Medicare and Medicaid Services released a revised conversion factor of $36.0791 (as opposed to the existing factor of $36.0846). http://www.OptumCoding.com/CodingCircleArticles/?id=814 Fri, 28 May 2010 00:00:00 -0500 Payment for the technical component (TC) for certain radiologic procedures will be reduced as a result of a provision in the Patient Protection and Affordable Care Act of 2009 (PPACA). http://www.OptumCoding.com/CodingCircleArticles/?id=813 Fri, 28 May 2010 00:00:00 -0500 Both the U.S. House of Representatives and the U.S. Senate have drafted proposed laws that would provide statutory updates to physician Medicare payment of 2.2 percent for the remainder of 2010 and an additional 1 percent increase in 2011. http://www.OptumCoding.com/CodingCircleArticles/?id=815 Fri, 28 May 2010 00:00:00 -0500 The Patient Protection and Affordable Care Act (PPACA), signed into law on March 23, 2010, shortened the time period allowed for filing Medicare fee-for-service (FFS) claims. The aim is to curb fraud, waste, and abuse in the Medicare program. http://www.OptumCoding.com/CodingCircleArticles/?id=812 Thu, 13 May 2010 00:00:00 -0500 Providers are reporting a great deal of confusion now that recovery audit contractors (RAC) are soliciting refunds by sending demand letters and recouping overpayment amounts through remittance advice offsets. http://www.OptumCoding.com/CodingCircleArticles/?id=810 Thu, 13 May 2010 00:00:00 -0500 Four more states and Puerto Rico have received federal money to implement electronic health records (EHR). http://www.OptumCoding.com/CodingCircleArticles/?id=811 Thu, 13 May 2010 00:00:00 -0500 The Medicare physician fee schedule will not receive an April update, according to a spokesperson for the Centers for Medicare and Medicaid Services (CMS). The next update is scheduled to become effective July 2010. http://www.OptumCoding.com/CodingCircleArticles/?id=774 Tue, 04 May 2010 00:00:00 -0500 On April 19, 2010, the Centers for Medicare & Medicaid Services (CMS) proposed the fiscal 2011 Medicare policies and payment rates for inpatient services provided by both acute care and long-term care hospitals. The proposed rule does not address provisions contained in the Patient Protection and Affordable Care Act or the Health Care and Education Affordability Reconciliation Act. The agency will address these provisions separately. http://www.OptumCoding.com/CodingCircleArticles/?id=777 Tue, 04 May 2010 00:00:00 -0500 The Centers for Medicare and Medicaid Services (CMS) has added code V12.53 (Personal history of sudden cardiac arrest) to the list of seven other codes not requiring modifier Q0 for coverage. http://www.OptumCoding.com/CodingCircleArticles/?id=809 Thu, 22 Apr 2010 00:00:00 -0500 As of April 1, 2010, hospitals are required to submit to Medicare separate claims for noncovered and covered services provided during the same inpatient stay. http://www.OptumCoding.com/CodingCircleArticles/?id=775 Thu, 22 Apr 2010 00:00:00 -0500 As part of the Patient Protection and Affordable Care Act that President Obama signed into law on March 23, the exceptions process for outpatient therapy caps was extended for another year (see section 3103). http://www.OptumCoding.com/CodingCircleArticles/?id=776 Thu, 22 Apr 2010 00:00:00 -0500 On March 16, the Centers for Medicare and Medicaid Services released new instructions for medical reviewers to follow regarding medical record authentication. http://www.OptumCoding.com/CodingCircleArticles/?id=769 Tue, 06 Apr 2010 00:00:00 -0500 The most recently published Comprehensive Error Rate Testing (CERT) report dated November 2009 indicates a paid claims error rate of 7.8 percent; the error rate for the previous year was 3.6 percent. The increase may be the result of significant revisions in the methods the Centers for Medicare and Medicaid Services (CMS) uses to identify and calculate paid claim error rates. It should be noted that due to these revisions, results from previous-year CERT reports cannot be directly compared with the 2009 report. http://www.OptumCoding.com/CodingCircleArticles/?id=772 Tue, 06 Apr 2010 00:00:00 -0500 In a recent transmittal, the Centers for Medicare and Medicaid Services indicated that there is no evidence supporting the conclusion that outpatient intravenous insulin treatment (OIVIT) improves health outcomes in Medicare patients. For this reason, CMS has determined that OIVIT is not reasonable and necessary and is a noncovered service. http://www.OptumCoding.com/CodingCircleArticles/?id=773 Tue, 06 Apr 2010 00:00:00 -0500 Hospitals treating patients with insulin-dependent diabetes mellitus are preparing for billing and coding changes for intravenous insulin therapy. http://www.OptumCoding.com/CodingCircleArticles/?id=770 Tue, 16 Mar 2010 00:00:00 -0500 With incentives for providers who implement an electronic health record (EHR) come increasing guidelines regarding the EHR. The Health Information Technology for Economic and Clinical Health Act (HITECH Act) includes guidelines for “meaningful use” requirements of the EHR. The meaningful use has been defined and includes creation of certification programs for health information technology. http://www.OptumCoding.com/CodingCircleArticles/?id=771 Tue, 16 Mar 2010 00:00:00 -0500 The Centers for Medicare and Medicaid Services (CMS) has indicated that due to a software snag, claims that Medicare contractors should have automatically sent to supplemental payers have not been sent, even though the remittance advice indicates otherwise. The problem began January 5, 2010, and has affected both Part A and Part B claims with the exception of those processed by durable medical equipment Medicare administrative contractors (DME MACs). http://www.OptumCoding.com/CodingCircleArticles/?id=766 Tue, 23 Feb 2010 00:00:00 -0600 Renal dialysis facilities will be required to report new quality data for dialysis adequacy, infection, and vascular access on all end-stage renal disease (ESRD) and hemodialysis claims on or after July 1, 2010. The new data reported will enable the Centers for Medicare & Medicaid Services (CMS) to implement a specific quality incentive payment for dialysis providers. http://www.OptumCoding.com/CodingCircleArticles/?id=767 Tue, 23 Feb 2010 00:00:00 -0600 The interim final rule, titled Breach Notification for Unsecured Protected Health Information, published in the Federal Register on August 24, 2009, requires that providers take extraordinary measures when patients’ medical information is released to unauthorized persons. http://www.OptumCoding.com/CodingCircleArticles/?id=768 Tue, 23 Feb 2010 00:00:00 -0600 The discontinuation of Medicare coverage for consultation services as of January 1, 2010, seems on the surface like a straightforward change to make. However, the drop in coverage also affects the reporting of evaluation and management (E/M) services in other, less obvious ways. http://www.OptumCoding.com/CodingCircleArticles/?id=808 Tue, 09 Feb 2010 00:00:00 -0600 On January 4, the Centers for Medicare and Medicaid Services (CMS) implemented new guidelines for determining the place of service (POS) for diagnostic tests. These guidelines were supposed to clarify billing instructions but have instead muddied the issue even more. http://www.OptumCoding.com/CodingCircleArticles/?id=764 Tue, 09 Feb 2010 00:00:00 -0600 Clinical diagnostic laboratories and other providers that bill Medicare for laboratory tests welcomed recent publications clarifying appropriate billing for certain tests. http://www.OptumCoding.com/CodingCircleArticles/?id=765 Tue, 09 Feb 2010 00:00:00 -0600 Medicare providers should take note of a special edition article alerting providers that certain Medicare payment provisions expired on December 31, 2009. In the article, the Centers for Medicare and Medicaid Services (CMS) also notes that potential new legislation that affects the Medicare program may extend these provisions. http://www.OptumCoding.com/CodingCircleArticles/?id=762 Tue, 26 Jan 2010 00:00:00 -0600 Effective August 3, 2009, warfarin responsiveness pharmacogenomic testing is covered only when provided to Medicare beneficiaries in the context of a prospective, randomized, controlled clinical study when that study meets certain criteria as outlined in Pub 100-03, section 90.1, of the National Coverage Determination Manual. http://www.OptumCoding.com/CodingCircleArticles/?id=763 Tue, 26 Jan 2010 00:00:00 -0600 In an ongoing effort to reduce waste, fraud, and abuse, the Centers for Medicare and Medicaid Services (CMS) is requiring certain durable medical equipment suppliers to post a surety bond and has revoked the billing privileges of more than 1,100 medical equipment suppliers in south Florida and southern California. http://www.OptumCoding.com/CodingCircleArticles/?id=805 Tue, 12 Jan 2010 00:00:00 -0600 The Centers for Medicare and Medicaid Services (CMS) has released new numbers for Part A and Part B contractors for Florida, Puerto Rico, and the United States Virgin Islands when that workload is transitioned to the Jurisdiction 9 A/B Medicare administrative contractor (MAC). Below are the changes and their effective dates. http://www.OptumCoding.com/CodingCircleArticles/?id=806 Tue, 12 Jan 2010 00:00:00 -0600 The Clinical Laboratory Improvement Amendments of 1988 (CLIA) regulations require that a provider be appropriately certified for each test performed. There are some tests, however, that are classified by the Food and Drug Administration (FDA) as being waived under CLIA. This means that any provider who has a certificate of waiver may perform these tests. http://www.OptumCoding.com/CodingCircleArticles/?id=807 Tue, 12 Jan 2010 00:00:00 -0600 On January 1, 2010, the Centers for Medicare and Medicaid Services (CMS) will roll out one of the most comprehensive revisions to OASIS since its original release in 1999. http://www.OptumCoding.com/CodingCircleArticles/?id=802 Tue, 22 Dec 2009 00:00:00 -0600 In addition to a new conversion factor and payment rates for 2010, ambulatory surgery centers are gearing up for changes that affect covered surgical procedures, payment indicators for office-based procedures, and newly created Level II HCPCS codes and payment rates for separately payable drugs and biologicals. http://www.OptumCoding.com/CodingCircleArticles/?id=803 Tue, 22 Dec 2009 00:00:00 -0600 In November, the Centers for Medicare and Medicaid Services detailed expansion of the number of reporting options eligible professionals (EPs) can use to report quality data when participating in the Physician Quality Reporting Initiative (PQRI) for 2010. Specifics are on the CMS website in the 2010 PQRI Implementation Guide and GPRO Narrative Measure Specifications for 2010. http://www.OptumCoding.com/CodingCircleArticles/?id=804 Tue, 22 Dec 2009 00:00:00 -0600 Medicare’s revamp of consultation coding policies has thrown many providers for a loop. http://www.OptumCoding.com/CodingCircleArticles/?id=799 Tue, 08 Dec 2009 00:00:00 -0600 Anesthesiologists and certified registered nurse anesthetists (CRNA) need to know about new payment rules effective for services furnished on or after January 1, 2010, if they bill Medicare for providing teaching anesthesia services for residents and student nurse anesthetists. http://www.OptumCoding.com/CodingCircleArticles/?id=800 Tue, 08 Dec 2009 00:00:00 -0600 E-prescribing is defined as a prescriber’s ability to electronically send an accurate, error-free and understandable prescription directly to a pharmacy from the point of care. It is an important element in improving patient quality of care. http://www.OptumCoding.com/CodingCircleArticles/?id=801 Tue, 08 Dec 2009 00:00:00 -0600 The calculations of Medicare fee-for-service error rates in 2009 will be significantly improved by the Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services, with an eye toward reducing waste, fraud, and abuse in the Medicare entitlement program. The new calculations will reflect a more complete accounting of Medicare’s improper payments than in previous years so that CMS can target improper payments more efficiently. http://www.OptumCoding.com/CodingCircleArticles/?id=796 Tue, 24 Nov 2009 00:00:00 -0600 Changes in Store for Cardiac and Pulmonary Rehabilitation for 2010 http://www.OptumCoding.com/CodingCircleArticles/?id=797 Tue, 24 Nov 2009 00:00:00 -0600 To incorporate changes in current medical practice, the Centers for Medicare & Medicaid Services (CMS) adopted new inpatient rehabilitation facility (IRF) coverage requirements in the fiscal 2010 final rule. http://www.OptumCoding.com/CodingCircleArticles/?id=798 Tue, 24 Nov 2009 00:00:00 -0600 If the final changes to policies and payment rates for the 2010 Medicare physician fee schedule go through as they are, physicians are looking at a negative 21.2 percent update to payments unless Congress takes action. The negative update is the result of the sustainable growth rate (SGR) update formula. This update has resulted in negative updates since 2003, but Congress has prevented the negative update legislatively since 2004. http://www.OptumCoding.com/CodingCircleArticles/?id=793 Tue, 10 Nov 2009 00:00:00 -0600 Consultation CPT codes will no longer be covered by Medicare, according to the Centers for Medicare and Medicaid Services (CMS). The agency has redistributed the value of the consultation codes across the other evaluation and management (E/M) codes for Medicare services. http://www.OptumCoding.com/CodingCircleArticles/?id=794 Tue, 10 Nov 2009 00:00:00 -0600 The Centers for Medicare and Medicaid Services (CMS) has released the details concerning changes to the Physician Quality Reporting Initiative (PQRI) for 2010. The agency has outlined how those changes will simplify participation in the program through expanded reporting options and increased numbers of individual measures as well as measure groups and additional reporting periods available for claims-based reporting. http://www.OptumCoding.com/CodingCircleArticles/?id=795 Tue, 10 Nov 2009 00:00:00 -0600 The American Medical Association (AMA) has released CPT® 2010; in addition to the 224 new codes, 155 revised codes and 76 deleted codes, the AMA has also begun a new numbering methodology that could be confusing initially. http://www.OptumCoding.com/CodingCircleArticles/?id=790 Tue, 27 Oct 2009 00:00:00 -0500 A wording change in the national coverage determination for magnetic resonance procedures (MRI) means that contractors can decide coverage for four procedures. http://www.OptumCoding.com/CodingCircleArticles/?id=791 Tue, 27 Oct 2009 00:00:00 -0500 Effective October 1, 2009, providers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) must be accredited and licensed for the product category they intend to submit a bid for to qualify for Medicare reimbursement. http://www.OptumCoding.com/CodingCircleArticles/?id=792 Tue, 27 Oct 2009 00:00:00 -0500 Those providing lab services should take particular note of the latest update of the edit module for clinical diagnostic laboratory services. Among the updates are several that affect some frequently used codes. http://www.OptumCoding.com/CodingCircleArticles/?id=787 Tue, 13 Oct 2009 00:00:00 -0500 Adverse events, home health resource group assignment, inpatient rehabilitation facility payment, and policies related to the American Recovery and Reinvestment Act of 2009 are just a few of the items on the Office of Inspector General’s list of issues to study in 2010. Being familiar with the OIG’s work plan each year helps health care providers assess their own compliance risks. http://www.OptumCoding.com/CodingCircleArticles/?id=788 Tue, 13 Oct 2009 00:00:00 -0500 Beginning October 1, the Centers for Medicare & Medicaid Services (CMS) is expanding its claim editing to ensure that items and services are ordered or referred only by physicians and other providers who are eligible to order/refer such services. Claims for services that require an ordering or referring provider must contain the national provider identifier (NPI) of the ordering/referring provider or the claim will not be paid. http://www.OptumCoding.com/CodingCircleArticles/?id=789 Tue, 13 Oct 2009 00:00:00 -0500 The Centers for Medicare and Medicaid Services (CMS) has released a memorandum detailing when the contractor can apply an exception to the clinical reasonable and necessary requirements of a local coverage determination. http://www.OptumCoding.com/CodingCircleArticles/?id=784 Tue, 22 Sep 2009 00:00:00 -0500 After months of providers wondering what types of claims the recovery audit contractors (RACs) would be examining, the Centers for Medicare and Medicaid Services has finally approved a number of issues to be audited. This allows providers of all types to see the areas that will receive the most focus so that they can perform internal audits to ensure that the correct coding and billing requirements have been followed. http://www.OptumCoding.com/CodingCircleArticles/?id=785 Tue, 22 Sep 2009 00:00:00 -0500 Under Medicare’s conditions of participation (CoP) and conditions of coverage (CfC), criteria for medical record authentication by physicians as well as on-call requirements have been revised. To continue participating in the Medicare and Medicaid programs, health care providers and accredited facilities must comply with these revisions. http://www.OptumCoding.com/CodingCircleArticles/?id=786 Tue, 22 Sep 2009 00:00:00 -0500 The Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS) released updated guidelines for ICD-9-CM coding which were created on 8/27/2009 and are effective as of 10/01/2009. The Official Guidelines for ICD-9-CM coding are approved by the Cooperating Parties for ICD-9-CM: the American Hospital Association (AHA), the American Health Information Management Association (AHIMA), CMS, and NCHS. http://www.OptumCoding.com/CodingCircleArticles/?id=781 Thu, 10 Sep 2009 00:00:00 -0500 The American Medical Association (AMA) has posted on its website coding advice on how to report the H1N1 (swine flu) vaccine and administration. According to the AMA, code 90663 is the appropriate code for reporting H1N1 vaccine administration. http://www.OptumCoding.com/CodingCircleArticles/?id=782 Thu, 10 Sep 2009 00:00:00 -0500 The Centers for Medicare and Medicaid Services (CMS) has released the October 2009 update to the HCPCS Level II coding system. This update contains only one new code and no deleted codes. http://www.OptumCoding.com/CodingCircleArticles/?id=783 Thu, 10 Sep 2009 00:00:00 -0500 Providers of durable medical equipment, prosthetics, orthotics, and supplies have to keep their eyes on a few dates in the next couple of months if they want to maintain their Medicare privileges or participate in the Medicare DMEPOS competitive bidding program. http://www.OptumCoding.com/CodingCircleArticles/?id=778 Tue, 25 Aug 2009 00:00:00 -0500 Hospitals will receive a 2.1 percent payment increase rather than an anticipated 1.9 percent reduction under the inpatient prospective payment system (IPPS), according to the final rule for fiscal year (FY) 2010, which was released on July 31st. The final rule policy changes and payment rates will affect inpatient services in general acute care hospitals, as well as long-term care hospitals (LTCHs), beginning with discharges on October 1, 2009. http://www.OptumCoding.com/CodingCircleArticles/?id=779 Tue, 25 Aug 2009 00:00:00 -0500 The Centers for Medicare & Medicaid Services (CMS) is contemplating coverage of HIV and genetic screening. http://www.OptumCoding.com/CodingCircleArticles/?id=780 Tue, 25 Aug 2009 00:00:00 -0500 Hospital outpatient departments, particularly those providing diagnostic and therapeutic services, would be significantly affected if proposed changes to the physician supervision regulations become final. The Centers for Medicare and Medicaid Services (CMS) proposed these changes in the 2010 hospital outpatient prospective payment system (HOPPS) proposed rule that updates policies and payment rates for hospital outpatient departments and ambulatory surgery centers for calendar year (CY) 2010. http://www.OptumCoding.com/CodingCircleArticles/?id=726 Tue, 11 Aug 2009 00:00:00 -0500 A recent Medicare transmittal has specified the proper billing of bilateral facet joint injections. The transmittal, published in July, addresses more than $100 million in improper payments to physicians and facilities identified by the Office of Inspector General (OIG). http://www.OptumCoding.com/CodingCircleArticles/?id=727 Tue, 11 Aug 2009 00:00:00 -0500 Computed tomography colonography has not been proved to be an appropriate colorectal cancer screening test under §1861(pp)(1) of the Social Security Act, the Centers for Medicare and Medicaid Services (CMS) announced in a final decision memorandum published on May 12, 2009. http://www.OptumCoding.com/CodingCircleArticles/?id=728 Tue, 11 Aug 2009 00:00:00 -0500 Under the recently released proposed rule for the Medicare physician fee schedule, physicians could see a whopping 21.5 percent decrease in payments for 2010, with a conversion factor of $28.3208. http://www.OptumCoding.com/CodingCircleArticles/?id=723 Tue, 28 Jul 2009 00:00:00 -0500 In addition to the projected 1.9 percent increase in Medicare payments for providers paid under the outpatient prospective payment system, the Centers for Medicare and Medicaid Services is proposing a number of additional policies that will affect payments. http://www.OptumCoding.com/CodingCircleArticles/?id=724 Tue, 28 Jul 2009 00:00:00 -0500 The Department of Health and Human Services (HHS) has rescinded three Medicaid regulations that limited outpatient hospital and clinic benefits and restricted access to case management services. http://www.OptumCoding.com/CodingCircleArticles/?id=725 Tue, 28 Jul 2009 00:00:00 -0500 Changes to the covered diagnosis codes for laboratory services are effective for services furnished on or after July 1, 2009. http://www.OptumCoding.com/CodingCircleArticles/?id=720 Tue, 14 Jul 2009 00:00:00 -0500 The latest version of the Correct Code Initiative (CCI) has been released by the Centers for Medicare and Medicaid Services (CMS). http://www.OptumCoding.com/CodingCircleArticles/?id=721 Tue, 14 Jul 2009 00:00:00 -0500 On June 16 the Health Information Technology Policy Committee took its first crack at trying to create a standard definition for “meaningful use” in relation to electronic health records (EHRs). This is significant because a provider must meet the criteria for meaningful use of a certified EHR if he or she wants to receive any incentive payments from Medicare authorized by the American Recovery and Reinvestment Act (ARRA). http://www.OptumCoding.com/CodingCircleArticles/?id=722 Tue, 14 Jul 2009 00:00:00 -0500 The Centers for Medicare and Medicaid Services (CMS) has released a new national coverage determination (NCD) indicating that effective January 15, 2009, CMS does not cover a particular surgical or other invasive procedure to treat a particular medical condition when the physician: Should have performed a different procedure altogether Performed the correct procedure but on the wrong body part Performed the correct procedure but on the wrong patient http://www.OptumCoding.com/CodingCircleArticles/?id=717 Tue, 23 Jun 2009 00:00:00 -0500 Minimal changes were made to the ICD-9-CM for 2010 in comparison to last year. The 2010 code updates were released earlier this month by the National Center for Health Statistics’ (NCHS) and the Centers for Medicare and Medicaid Services (CMS). The changes are effective October 1, 2009. http://www.OptumCoding.com/CodingCircleArticles/?id=718 Tue, 23 Jun 2009 00:00:00 -0500 The second six-month reporting period for Medicare’s Physician Quality Reporting Initiative(PQRI) begins July 1. This reporting period runs through December 31, 2009, and gives providers who have not already started a chance to meet the PQRI reporting criteria for 2009 and receive an incentive payment when reporting thresholds are met. http://www.OptumCoding.com/CodingCircleArticles/?id=719 Tue, 23 Jun 2009 00:00:00 -0500 The proposed inpatient prospective payment system (IPPS) rule for fiscal 2010 issued by the Centers for Medicare & Medicaid Services (CMS) on May 1 includes changes to payment rates and policies for inpatient services beginning October 1, 2009. The proposed payment and policy changes affect inpatient stays in acute care and long-term care hospitals (LTCHs). http://www.OptumCoding.com/CodingCircleArticles/?id=714 Tue, 09 Jun 2009 00:00:00 -0500 The Centers for Medicare and Medicaid Services has released a transmittal clarifying how to bill for routine foot care when payment ceases for loss of protective sensation (LOPS) evaluation and management. http://www.OptumCoding.com/CodingCircleArticles/?id=715 Tue, 09 Jun 2009 00:00:00 -0500 From now until the summer of 2011, 14 selected communities have been chosen to participate in the pilot Care Transitions Project to determine the reasons for unnecessary hospital readmissions and eliminate them. Data have demonstrated that one in five patients discharged from a hospital with be readmitted within the month, and as many as 75 percent of these admissions could be prevented. http://www.OptumCoding.com/CodingCircleArticles/?id=716 Tue, 09 Jun 2009 00:00:00 -0500 Although the official ICD-9-CM addendum for volumes 1, 2, and 3 has not been released, we can still get a glimmer of the changes we will face for fiscal year 2010. The code count below is based upon the new and revised code list released with the proposed rule for the inpatient prospective payment system (IPPS) for fiscal 2010 and as posted on the Centers for Medicare and Medicaid Services ICD-9-CM website. There may still be modifications made once the addendum is released. http://www.OptumCoding.com/CodingCircleArticles/?id=693 Tue, 26 May 2009 00:00:00 -0500 The Centers for Medicare & Medicaid Services (CMS) is changing all national coverage determinations (NCDs) that address coverage of FDG (fluoro-2-deoxy-D-glucose) positron emission tomography, or PET scan, for specific oncology conditions, while maintaining current coverage. http://www.OptumCoding.com/CodingCircleArticles/?id=694 Tue, 26 May 2009 00:00:00 -0500 The Centers for Medicare and Medicaid Services is revising its criteria for approving or denying a request for a new physician specialty code. http://www.OptumCoding.com/CodingCircleArticles/?id=713 Tue, 26 May 2009 00:00:00 -0500 The Joint Commission has refined the scoring and decision process for the Hospital Accreditation Program, as detailed in a March addendum to its accreditation standards. http://www.OptumCoding.com/CodingCircleArticles/?id=690 Tue, 12 May 2009 00:00:00 -0500 The Centers for Medicare and Medicaid Services has indicated that, as of October 5, 2009, claims will be edited to determine that the ordering/referring provider identified by the national provider identifier (NPI) on a claim is enrolled in Medicare and is eligible to order or refer services. The edits will be phased in in two parts. http://www.OptumCoding.com/CodingCircleArticles/?id=691 Tue, 12 May 2009 00:00:00 -0500 The Centers for Medicare and Medicaid Services has recently updated the list of procedures approved as telehealth services. This update was necessary since in 2009 several new CPT procedure codes related to end-stage renal disease (ESRD) services were added, replacing previous HCPCS level II G codes, which were then deleted. Telehealth services must be reported with modifiers GT or GQ appended to the code to identify the type of technology used. http://www.OptumCoding.com/CodingCircleArticles/?id=692 Tue, 12 May 2009 00:00:00 -0500 The Centers for Medicare & Medicaid Services (CMS) is soliciting nursing homes and skilled nursing facilities in New York, Arizona, Mississippi, and Wisconsin to participate in a three-year, pay-for-performance demonstration program beginning in summer 2009. http://www.OptumCoding.com/CodingCircleArticles/?id=687 Tue, 28 Apr 2009 00:00:00 -0500 In a recent Physician Quality Reporting Initiative (PQRI) open door forum, the Centers for Medicare & Medicaid Services (CMS) listed some of the most common errors in claim-based reporting along with tips to help physicians meet the criteria for receiving the 2 percent incentive payment. http://www.OptumCoding.com/CodingCircleArticles/?id=688 Tue, 28 Apr 2009 00:00:00 -0500 The Centers for Medicare & Medicaid Services (CMS) has just released a national coverage determination (NCD) that states that certain bariatric procedures will be covered when specific criteria are met. http://www.OptumCoding.com/CodingCircleArticles/?id=689 Tue, 28 Apr 2009 00:00:00 -0500 The Centers for Medicare and Medicaid Services (CMS) issued changes to the Ambulatory Surgical Center (ASC) Payment System beginning April 1, 2009. These policy revisions include payment rates for new Level II Healthcare Common Procedure Coding System (HCPCS) codes for drugs and biologicals (e.g., C9249, Injection, certolizumab pegol, 1 mg). CMS also updated covered surgical procedures and ancillary services to include new HCPCS codes. http://www.OptumCoding.com/CodingCircleArticles/?id=684 Tue, 14 Apr 2009 00:00:00 -0500 The Office of Inspector General (OIG) has released a report indicating that after a review of high-dollar payments for inpatient services processed by National Government Services in Illinois, Indiana, Kentucky, and Ohio for calendar years 2004 through 2006, only 39 of the 303 services were paid correctly. This audit was performed as part of a nationwide review of payments for inpatient services of $200,000 or more (high-dollar payments). http://www.OptumCoding.com/CodingCircleArticles/?id=685 Tue, 14 Apr 2009 00:00:00 -0500 Part B providers can no longer deny that they will be undergoing scrutiny by Recovery Audit Contractors (RAC audits)—the Centers for Medicare and Medicaid Services will be holding an Open Door Forum on April 14 from 2:00-3:30 PM ET. The purpose of this special open door forum is to discuss the program and introduce the contractors. For more information about how to participate, go to the CMS website at http://www.cms.hhs.gov/OpenDoorForums/23_ODF_PNAHP.asp http://www.OptumCoding.com/CodingCircleArticles/?id=686 Tue, 14 Apr 2009 00:00:00 -0500 Upcoding and other fraudulent and abusive practices contributed to an alarming increase in overutilization of and Medicare spending on home health services between 2002 and 2006, according to a study completed by the Government Accounting Office. http://www.OptumCoding.com/CodingCircleArticles/?id=681 Tue, 24 Mar 2009 00:00:00 -0500 The House and Senate recently announced the formation of the United States Bipartisan Commission on Access to Emergency Medical Services. This commission was formed to identify and examine factors that affect delivery of screening and stabilization services in hospitals with emergency departments. http://www.OptumCoding.com/CodingCircleArticles/?id=682 Tue, 24 Mar 2009 00:00:00 -0500 The Centers for Medicare and Medicaid Services has released version 15.1 of the correct coding initiative (CCI) edits. This latest version, effective April 1, includes all previous versions and updates from January 1, 1996, to the present. http://www.OptumCoding.com/CodingCircleArticles/?id=683 Tue, 24 Mar 2009 00:00:00 -0500 The stimulus bill signed into law last month provides up to $44,000 per provider in financial incentives to encourage physicians and hospitals to fully adopt electronic records by 2015. The American Recovery and Reinvestment Act of 2009 (ARRA) allocates approximately $19 billion to Medicare and Medicaid to fund health information technology (HIT). http://www.OptumCoding.com/CodingCircleArticles/?id=760 Tue, 10 Mar 2009 00:00:00 -0500 The Centers for Medicare and Medicaid Services (CMS) has released the April update to the Medicare physician fee schedule. These revisions go into effect April 1. http://www.OptumCoding.com/CodingCircleArticles/?id=761 Tue, 10 Mar 2009 00:00:00 -0500 The Centers for Medicare and Medicaid Services (CMS) has released the latest round of CLIA waived tests. These tests may be performed by providers who have a certificate of waiver under the Clinical Laboratory Improvements Act. http://www.OptumCoding.com/CodingCircleArticles/?id=680 Tue, 10 Mar 2009 00:00:00 -0500 A recent Centers for Medicare and Medicaid Services (CMS) transmittal instructs contractors to more stringently enforce current policies aimed at preventing separate payment for procedures performed during the global surgery period. http://www.OptumCoding.com/CodingCircleArticles/?id=757 Tue, 24 Feb 2009 00:00:00 -0600 A recent review of facet-joint injections performed in 2006 revealed that approximately 63 percent of these services did not meet Medicare guidelines and resulted in an estimated $96 million dollars in improper payments to providers and $33 million to facilities. These injections are a type of interventional pain management technique used to diagnose or treat back pain. http://www.OptumCoding.com/CodingCircleArticles/?id=758 Tue, 24 Feb 2009 00:00:00 -0600 The Centers for Medicare and Medicaid has issued instructions to contractors outlining when anti-markup payment limitations apply to diagnostic services. These guidelines are effective July 1, 2009. http://www.OptumCoding.com/CodingCircleArticles/?id=759 Tue, 24 Feb 2009 00:00:00 -0600 Three recently released national coverage determinations aim to eliminate specific preventable surgical errors and payments for services relating to them. The errors these NCDs address are included in the National Quality Forum’s (NQF) list of 28 “serious reportable events,” which are both serious and preventable. These events are commonly known as “never events.” http://www.OptumCoding.com/CodingCircleArticles/?id=754 Tue, 10 Feb 2009 00:00:00 -0600 The Correct Coding Initiative edits that went into effect for professional claims on January 1, 2009 (version 15.0), include thousands of changes that are already affecting claims. As bundling is frequently the reason for claim denials, it is essential for providers to keep up-to-date with the quarterly updates to CCI edits. http://www.OptumCoding.com/CodingCircleArticles/?id=755 Tue, 10 Feb 2009 00:00:00 -0600 The 2007 United States health care spending increased at the lowest rate of growth in nearly a decade, the Centers for Medicare and Medicaid Services announced in January. Even so, health care spending consumed a larger share of our gross domestic product. http://www.OptumCoding.com/CodingCircleArticles/?id=756 Tue, 10 Feb 2009 00:00:00 -0600 October 1, 2013, is the new compliance date for use of ICD-10-CM and ICD-10-PCS (inpatient services only) code sets for all covered entities, according to a final rule published January 16 in the Federal Register. A 60-day delay in the effective date of the rule is a requirement of the original Health Insurance Portability and Accountability Act (HIPAA) regulations to allow Congress and the Administration a chance to review the rules. http://www.OptumCoding.com/CodingCircleArticles/?id=751 Tue, 27 Jan 2009 00:00:00 -0600 On January 1, Medicare announced that there would be an emergency update to the physician fee schedule. The change affects all providers who file claims with Medicare contractors. http://www.OptumCoding.com/CodingCircleArticles/?id=752 Tue, 27 Jan 2009 00:00:00 -0600 It has never been easier to enroll in Medicare or change your enrollment information, thanks to a new, secure internet-based program. http://www.OptumCoding.com/CodingCircleArticles/?id=753 Tue, 27 Jan 2009 00:00:00 -0600 The CPT® book has two groups of psychotherapy services. One group should be used to report office or outpatient therapy, and the other should be used for inpatient, residential, and partial hospitalization services. CPT® codes 90816 through 90829 should only be reported for inpatient, residential, and partial hospitalization program (PHP) services. CPT® instructions direct to report codes 90804 through 90815 for office or hospital outpatient individual psychotherapy services that are not part of PHP services. http://www.OptumCoding.com/CodingCircleArticles/?id=748 Tue, 23 Dec 2008 00:00:00 -0600 Skilled therapy services usually require the skills of qualified therapists, are performed for restorative purposes, and generally involve ongoing treatments as part of a therapy plan of care. In contrast, a non-therapy service is a service performed by non-therapist and without an appropriate plan of care or goals. http://www.OptumCoding.com/CodingCircleArticles/?id=749 Tue, 23 Dec 2008 00:00:00 -0600 In the transition from charged-based to cost-based relative weight calculations, CMS has significantly revised the MS-DRG relative weight (RW) values for fiscal year 2009. Coding professionals and other hospital staff should be aware of these revisions because previous optimization strategies may no longer be valid. In general, DRG subgroups with a “with MCC” split had the most substantial RW changes, with the “with MCC” RW values rising, in some cases very dramatically. http://www.OptumCoding.com/CodingCircleArticles/?id=750 Tue, 23 Dec 2008 00:00:00 -0600 The dozens of new HCPCS Level II codes released in the 2009 update are wide ranging. They were added to 10 chapters and describe such diverse things as compression wrap, saliva analysis, and pelvic fracture treatment. http://www.OptumCoding.com/CodingCircleArticles/?id=661 Tue, 09 Dec 2008 00:00:00 -0600 In part one of this series, we discussed the many new codes that have been added to HCPCS for 2009, as well as some of those that were deleted but then replaced. This article lists the codes that were reinstated, added and deleted the same year, and revised since the 2008 annual update. HCPCS codes are updated quarterly. To see a complete list of all of the 2009 HCPCS codes, refer to the CMS website at: http://www.cms.hhs.gov/HCPCSReleaseCodeSets/ANHCPCS/list.asp. http://www.OptumCoding.com/CodingCircleArticles/?id=746 Tue, 09 Dec 2008 00:00:00 -0600 It comes as no surprise that the annual HCPCS code update affects many of the codes relevant to the method of reporting data for the Physician Quality Reporting Initiative (PQRI), which includes groups of clinically related measures rather than individual measures. http://www.OptumCoding.com/CodingCircleArticles/?id=747 Tue, 09 Dec 2008 00:00:00 -0600 The latest update to the remittance advice remark codes (RARC) includes four new codes, one deactivated code, and one modified code. The update is effective January 5th. http://www.OptumCoding.com/CodingCircleArticles/?id=658 Tue, 25 Nov 2008 00:00:00 -0600 The Centers for Medicare and Medicaid Services has announced that effective January 5, 2008, a hospital-based or critical access hospital-based renal dialysis center (including satellites); a skilled nursing facility, and a community mental health center will be considered originating entities for payment of telehealth services. http://www.OptumCoding.com/CodingCircleArticles/?id=659 Tue, 25 Nov 2008 00:00:00 -0600 The changes to the Medicare deductible and coinsurance amounts for next year are not as significant as they have been in past years. http://www.OptumCoding.com/CodingCircleArticles/?id=660 Tue, 25 Nov 2008 00:00:00 -0600 The update to the physician fee schedule for 2009, released in a final rule on October 30, includes a 1.1 percent increase mandated by Congress in the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). This means that, beginning January 1, 2009, the conversion factor for determining Medicare payments will be $36.0666. http://www.OptumCoding.com/CodingCircleArticles/?id=655 Tue, 11 Nov 2008 00:00:00 -0600 Among the most significant elements of the October 30 final rule updating the outpatient prospective payment system and the ambulatory surgery center payment rates for 2009 are reduced payment for lack of quality measures, and new quality measures, imaging composite ambulatory payment classifications, and emergency visit APCs. http://www.OptumCoding.com/CodingCircleArticles/?id=656 Tue, 11 Nov 2008 00:00:00 -0600 The final rule for the Medicare physician fee schedule has greatly expanded the Physician Quality Reporting Initiative for 2009. http://www.OptumCoding.com/CodingCircleArticles/?id=657 Tue, 11 Nov 2008 00:00:00 -0600 Although the revisions to the 2009 edition of CPT® may look less intimidating than those from past years, the nature of the changes are anything but (for example, the evaluation and management section alone has 15 deletions and 17 new codes). The changes, released by the American Medical Association this month, affect all practices, regardless of their specialty. http://www.OptumCoding.com/CodingCircleArticles/?id=652 Tue, 28 Oct 2008 00:00:00 -0500 When the Centers for Medicare and Medicaid Services announced it would be replacing Medicare fiscal intermediaries and carriers with the new Medicare administrative contractors (MACs), it said one of the benefits would be that claims processing would be quicker and easier for providers. Physicians are finding quite the opposite. http://www.OptumCoding.com/CodingCircleArticles/?id=653 Tue, 28 Oct 2008 00:00:00 -0500 If the Centers for Medicare and Medicaid Services decides to cover computed tomography colonography, other payers could follow suit. The agency is conducting a national coverage analysis and plans to release a proposed decision in February 2009. http://www.OptumCoding.com/CodingCircleArticles/?id=654 Tue, 28 Oct 2008 00:00:00 -0500 Influenza or pneumococcal vaccine claims submitted as roster bills need not include a national provider identifier (NPI), according to the Centers for Medicare and Medicaid Services. http://www.OptumCoding.com/CodingCircleArticles/?id=649 Tue, 14 Oct 2008 00:00:00 -0500 Once a provider starts receiving electronic funds transfer payments under Medicare, receiving a paper check is rarely an option, according to the Centers for Medicare and Medicaid Services. CMS requires electronic funds transfer payments for all new providers as well as existing providers who have submitted a change to their existing provider file but are not currently enrolled in EFT. http://www.OptumCoding.com/CodingCircleArticles/?id=650 Tue, 14 Oct 2008 00:00:00 -0500 On October 1, 2008, the Centers for Medicare and Medicaid Services published more than a quarter of the medically unlikely edits. In the past the agency has maintained the proprietary nature of the edits. Edits intended to detect and discourage any questionable payments will not be published, as the agency feels the efficacy of these edits would be compromised. http://www.OptumCoding.com/CodingCircleArticles/?id=651 Tue, 14 Oct 2008 00:00:00 -0500 In an August 22 report, the Office of Inspector General recommended that the Centers for Medicare & Medicaid Services expand the review process for its Comprehensive Error Rate Testing program to ensure accurate measurement of payment errors for durable medical equipment, prosthetics, orthotics and supplies (DME POS). http://www.OptumCoding.com/CodingCircleArticles/?id=646 Tue, 23 Sep 2008 00:00:00 -0500 Providers should determine which of 32 registries recently approved for quality reporting meets their specific needs. http://www.OptumCoding.com/CodingCircleArticles/?id=647 Tue, 23 Sep 2008 00:00:00 -0500 In a recent transmittal, the Centers for Medicare and Medicaid Services clarified which diagnostic services do not require an order with a physician signature under the Medicare program. The agency went on to note that even for those services, there still must be documentation in both the ordering and performing providers’ records indicating the ordering physician’s intent to have the tests performed. http://www.OptumCoding.com/CodingCircleArticles/?id=648 Tue, 23 Sep 2008 00:00:00 -0500 This year 331 new ICD-9-M codes become effective October 1, 2008. Of those, 30 cover the numerous variations of headaches and migraines. One thing to note is there will be new and revised fifth-digit options for these new codes. These fifth-digit options will allow the provider to indicate the presence of status migrainosus, which is an acute migraine headache that lasts 72 hours or longer. http://www.OptumCoding.com/CodingCircleArticles/?id=744 Tue, 09 Sep 2008 00:00:00 -0500 If the federal government gets its way, by the fall of 2011, ICD-10-CM will replace ICD-9-CM, volumes 1 and 2, as the standard code set for covered entities for reporting and coding diseases, injuries, impairments, other health problems and their manifestations. http://www.OptumCoding.com/CodingCircleArticles/?id=745 Tue, 09 Sep 2008 00:00:00 -0500 The Food and Drug Administration announced that it has approved this year's influenza vaccines, which include new strains of the virus during the 2008–2009 season. http://www.OptumCoding.com/CodingCircleArticles/?id=645 Tue, 09 Sep 2008 00:00:00 -0500 The Centers for Medicare and Medicaid Services proposes changing the way multiple imaging procedures are paid to reflect and promote efficiencies in performing multiple imaging procedures during a single session. http://www.OptumCoding.com/CodingCircleArticles/?id=741 Tue, 26 Aug 2008 00:00:00 -0500 Continuous positive airway pressure (CPAP) based upon a diagnosis of obstructive sleep apnea (OSA) confirmed by home sleep testing (HST) is now covered by Medicare. http://www.OptumCoding.com/CodingCircleArticles/?id=742 Tue, 26 Aug 2008 00:00:00 -0500 There’s a new ICD-9-CM category and 20 new codes describing secondary diabetes for fiscal 2009. Category 249 Secondary diabetes mellitus closely parallels category 250 Diabetes mellitus. http://www.OptumCoding.com/CodingCircleArticles/?id=743 Tue, 26 Aug 2008 00:00:00 -0500 The Centers for Medicare and Medicaid Services (CMS) announced a revision to National Coverage Determination 190.11 on July 25 that provides coverage for the use of home PT (Prothrombin Time) /INR (Internation Normalized Ratio)monitoring for chronic, oral anticoagulation management for patients with mechanical heart valves, chronic atrial fibrillation, or venous thromboembolism (inclusive of deep venous thrombosis and pulmonary embolism) who are on warfarin. Prior to this revision, coverage was mandated only for patients with mechanical heart valves. http://www.OptumCoding.com/CodingCircleArticles/?id=738 Tue, 12 Aug 2008 00:00:00 -0500 The Centers for Medicare & Medicaid Services (CMS) has announced that more than $36 million in bonus payments has been made to providers who met the reporting criteria for participating in the 2007 Physician Quality Reporting Initiative (PQRI). http://www.OptumCoding.com/CodingCircleArticles/?id=739 Tue, 12 Aug 2008 00:00:00 -0500 It seems like such a simple thing to do but the Office of Inspector General has stated that 85 out of 100 claims processed by First Coast Service Options, Inc. during 2004 and 2005 could have possible place of service (POS) errors. This could result in an estimated $1.5 million in claims were paid that may have had an incorrect place of service indicated. As a result, Providers in Florida and Connecticut may be seeing a request for refund of overpayments soon. http://www.OptumCoding.com/CodingCircleArticles/?id=740 Tue, 12 Aug 2008 00:00:00 -0500 On July 9 Congress passed the Medicare Improvement for Patients and Providers Act of 2008, legislation that, among other things, not only prevents the 10.6 percent cut in physician payment that was supposed to take effect July 1, but replaces it with a 0.5 percent increase effective until December 31, 2008. http://www.OptumCoding.com/CodingCircleArticles/?id=737 Tue, 22 Jul 2008 00:00:00 -0500 The results are in: The Recovery Audit Contractors (RACs) Demonstration Program was a whopping success with $693.6 million in improper Medicare payments returned to the Medicare trust funds between 2005 and March 2008. http://www.OptumCoding.com/CodingCircleArticles/?id=733 Tue, 22 Jul 2008 00:00:00 -0500 Billing of the technical portion of pathology services has just gotten simpler—or more complex—depending on which side of the fence you are on. As of June 30, independent laboratories will no longer be paid separately by Medicare for services performed for a hospitalized patient, either in- or outpatient. http://www.OptumCoding.com/CodingCircleArticles/?id=736 Tue, 22 Jul 2008 00:00:00 -0500 Once again, providers face a possible reduction in rates, according to the proposed revisions to the 2009 Medicare physician fee schedule (MPFS) released on June 30th. The Centers for Medicare & Medicaid Services (CMS) is proposing a reduction of 5.4 percent in physician fee schedule payment. http://www.OptumCoding.com/CodingCircleArticles/?id=734 Tue, 08 Jul 2008 00:00:00 -0500 The Centers for Medicare & Medicaid Services (CMS) is proposing to expand the physician quality reporting initiative (PQRI) by adding 62 new measures and expanding reporting methodologies. http://www.OptumCoding.com/CodingCircleArticles/?id=735 Tue, 08 Jul 2008 00:00:00 -0500 For calendar year 2008, Medicare Part B will provide benefits for a specimen collection fee as well as a travel allowance for a laboratory technician to draw a specimen from a nursing home patient or homebound patient, with payment based on the clinical laboratory fee schedule. http://www.OptumCoding.com/CodingCircleArticles/?id=730 Tue, 24 Jun 2008 00:00:00 -0500 Below is a list of the latest waived tests approved by the Food and Drug Administration under the Clinical Laboratory Improvement Amendments of 1988 (CLIA). These test codes will include a QW modifier to be attached to the appropriate CPT® code to flag waived tests billed by facilities. http://www.OptumCoding.com/CodingCircleArticles/?id=731 Tue, 24 Jun 2008 00:00:00 -0500 A new demonstration project will reward physician practices that deliver high-quality care supported by the adoption of electronic health records. http://www.OptumCoding.com/CodingCircleArticles/?id=732 Tue, 24 Jun 2008 00:00:00 -0500 So far 2009 looks like a record-breaking year for the number and breadth of changes to the ICD-9-CM code set. http://www.OptumCoding.com/CodingCircleArticles/?id=711 Tue, 10 Jun 2008 00:00:00 -0500 The American Medical Association has released a summary of where the code revisions to the 2009 CPT® code book are to occur, and the changes appear to be substantial with more than 500 revisions. When combined with the more the 300 new ICD-9-CM codes, providers will have their hands full updating systems with the new and revised codes over then next few months. http://www.OptumCoding.com/CodingCircleArticles/?id=712 Tue, 10 Jun 2008 00:00:00 -0500 PQRI final feedback reports for 2007 will be made available in mid-July on a secure website. Reports will be available to each practice using the taxpayer identification number (TIN) under which at least one eligible provider reported 2007 PQRI quality measures data. The reports will include information on reporting rates, clinical performance, and incentives earned by individual providers as well as a summary on reporting success and incentives earned at the practice (TIN) level. http://www.OptumCoding.com/CodingCircleArticles/?id=729 Tue, 10 Jun 2008 00:00:00 -0500 As of this September, all providers—including independent laboratories, physicians, practitioners, and suppliers—will be required to use the revised advance beneficiary notice (ABN) for all situations in which Medicare payment is expected to be denied. http://www.OptumCoding.com/CodingCircleArticles/?id=708 Tue, 27 May 2008 00:00:00 -0500 The Centers for Medicare and Medicaid Services (CMS) released the inpatient prospective payment system (IPPS) proposed rule on April 30, 2008, continuing the transition to Medicare severity (MS) diagnosis-related groups (DRGs), along with other ongoing payment revisions. http://www.OptumCoding.com/CodingCircleArticles/?id=709 Tue, 27 May 2008 00:00:00 -0500 The Centers for Medicare & Medicaid Services (CMS) is proposing to expand the list of conditions that are reasonably preventable through proper care and for which Medicare will no longer pay at a higher rate if the patient acquires them during a hospital stay. http://www.OptumCoding.com/CodingCircleArticles/?id=710 Tue, 27 May 2008 00:00:00 -0500 The Centers for Medicare and Medicaid Services (CMS) has made revisions to the Physician Quality Reporting Initiative (PQRI) program that should make participating and meeting the reporting threshold easier for providers—which in turn should make your receiving the 1.5 percent incentive payment more likely. http://www.OptumCoding.com/CodingCircleArticles/?id=705 Tue, 13 May 2008 00:00:00 -0500 New guidelines released by the Centers for Medicare and Medicaid Services (CMS) address the increase in the number of services reported as “incident to.” http://www.OptumCoding.com/CodingCircleArticles/?id=706 Tue, 13 May 2008 00:00:00 -0500 Treatment of chronic nonhealing wounds using platelet-rich plasma (PRP) is still noncovered, according to a coverage policy recently updated by The Centers for Medicare and Medicaid Services (CMS). http://www.OptumCoding.com/CodingCircleArticles/?id=707 Tue, 13 May 2008 00:00:00 -0500 In a further advance towards value-based purchasing, the Centers for Medicare and Medicaid Services (CMS) is initiating an acute care episode (ACE) demonstration project effective for admissions occurring on or after October 1, 2008. http://www.OptumCoding.com/CodingCircleArticles/?id=702 Tue, 22 Apr 2008 00:00:00 -0500 After a careful review of the medical evidence, the Centers for Medicare and Medicaid Services (CMS) determined that Medicare coverage of PTA of the renal arteries and PTA concurrent with renal artery stent placement should not be changed. Therefore, PTA with concurrent stent placement coverage is at the discretion of local Medicare contractors. http://www.OptumCoding.com/CodingCircleArticles/?id=703 Tue, 22 Apr 2008 00:00:00 -0500 The Centers for Medicare and Medicaid Services (CMS) has released the latest update to the HCPCS Level II code system. There changes, effective April 1, include: http://www.OptumCoding.com/CodingCircleArticles/?id=704 Tue, 22 Apr 2008 00:00:00 -0500 Are you correctly reporting the present-on-admission (POA) indicator for all diagnoses on claims for inpatient visits? It matters because effective April 1, 2008, if the POA indicators are missing, Medicare will return the claim and delay payment. http://www.OptumCoding.com/CodingCircleArticles/?id=699 Tue, 08 Apr 2008 00:00:00 -0500 National Government Services is the latest Medicare administrative contractor to be selected through competitive bidding to administer claims in one of 15 national jurisdictions. The bulk of jurisdictions have yet to be awarded. http://www.OptumCoding.com/CodingCircleArticles/?id=700 Tue, 08 Apr 2008 00:00:00 -0500 Cardiologists and radiologists got a reprieve from further cuts to medical imaging reimbursement when the Centers for Medicare and Medicaid Services (CMS) announced it will not implement proposed changes that would have drastically limited Medicare coverage of computed tomographic angiography (CTA). CMS released “Coverage Decision Memorandum for Cardiac Computed Tomographic Angiography for the Diagnosis of Coronary Artery Disease” (CAG-00385N) on March 12, 2008. http://www.OptumCoding.com/CodingCircleArticles/?id=701 Tue, 08 Apr 2008 00:00:00 -0500 The Centers for Medicare and Medicaid Services (CMS) announced that it will begin conducting onsite reviews and investigations to evaluate Health Insurance Portability and Accountability Act (HIPAA) Security Rule compliance; violations are subject to penalties. Information was posted on the CMS Web site on February 20 regarding these onsite HIPAA security investigations and compliance reviews. http://www.OptumCoding.com/CodingCircleArticles/?id=696 Tue, 25 Mar 2008 00:00:00 -0500 The Centers for Medicare and Medicaid Services (CMS) has revised its Advance Beneficiary Notices (ABN) form (CMS 141G). In order to clarify the purpose of the form, it is now titled the Advance Beneficiary Notice of Noncoverage. Providers, suppliers, independent laboratories, physicians, and other practitioners began using the new ABN on March 3, 2008. The revised ABN replaces the existing ABN-G (Form CMS-R-131G) and ABN-L (Form CMS-R-131L). http://www.OptumCoding.com/CodingCircleArticles/?id=697 Tue, 25 Mar 2008 00:00:00 -0500 Medicare has recovered millions of dollars from physicians and nonphysician practitioners (NPP) who incorrectly bill professional Evaluation and Management (E/M) services or bill E/M levels that are not supported by the documentation of the encounter or by the patient`s actual condition. So physicians and NPPs may want to closely review the billing and documentation requirements before billing inpatient hospital visits and critical care services provided on the same day. http://www.OptumCoding.com/CodingCircleArticles/?id=698 Tue, 25 Mar 2008 00:00:00 -0500 On February 28, the Centers for Medicare and Medicaid Services (CMS) announced that the Recovery Audit Contractor (RAC) program identified $371.5 million in improper Medicare payments in just three states in 2007. http://www.OptumCoding.com/CodingCircleArticles/?id=678 Tue, 11 Mar 2008 00:00:00 -0500 The Centers for Medicare and Medicaid Services (CMS) has issued a final rule providing for medical necessity determination of coverage for certain physician services before these services are rendered. The intention is to enable the physician and beneficiary to know the financial liability for a service before expenses are incurred. http://www.OptumCoding.com/CodingCircleArticles/?id=679 Tue, 11 Mar 2008 00:00:00 -0500 Certain covered bone mass measurement (BMM) tests are being denied in error, despite an established national coverage determination. In response, the Centers for Medicare and Medicaid Services has issued a transmittal clarifying the claims processing instructions for BMM tests. http://www.OptumCoding.com/CodingCircleArticles/?id=695 Tue, 11 Mar 2008 00:00:00 -0500 What seemed to be established policy regarding separate billing for critical care services is now up in the air if a new communication from the Centers for Medicare and Medicaid Services (CMS) is correct. http://www.OptumCoding.com/CodingCircleArticles/?id=675 Tue, 26 Feb 2008 00:00:00 -0600 Effective April 1, 2008, the Centers for Medicare and Medicaid Services (CMS) will implement a recurring edit module in the carrier processing system to allow program safeguard contractors (PSCs) or CMS to monitor beneficiary and provider numbers they have identified as problematic. The new edits will be especially helpful when identity theft is suspected, but it may slow down legitimate claims. http://www.OptumCoding.com/CodingCircleArticles/?id=676 Tue, 26 Feb 2008 00:00:00 -0600 Beginning April 1, 2008, a new HCPCS Level II K code becomes effective for replacement interface material. This code should be used when submitting claims for the replacement of lower extremity removable soft interfaces only. http://www.OptumCoding.com/CodingCircleArticles/?id=677 Tue, 26 Feb 2008 00:00:00 -0600 Medicare fee-for-service transactions will require providers to report only the national provider identifier (NPI) beginning May 23, 2008; legacy provider identifier numbers will no longer be permitted on form CMS-1500 or form CMS-1450 claims (except in certain the situations defined below). Claims containing legacy provider identifiers will be returned, without appeal rights. http://www.OptumCoding.com/CodingCircleArticles/?id=672 Tue, 12 Feb 2008 00:00:00 -0600 A demonstration project starting up this October will dramatically change the way providers in the project will be paid. The Acute Care Episode (ACE) Demonstration is specifically designed to align incentives and provide flexibility to hospitals and physicians by bundling all related services into an “episode of care.” A single, global payment then will be used as the providers of care deem most appropriate. http://www.OptumCoding.com/CodingCircleArticles/?id=673 Tue, 12 Feb 2008 00:00:00 -0600 By correctly billing for a service many providers are already performing, practices could see increased revenues. Many providers are not aware that Medicare covers eight smoking and tobacco use cessation counseling sessions in a year—and that another eight sessions are paid for during a second or subsequent year once 11 full months have passed since the first covered visit. http://www.OptumCoding.com/CodingCircleArticles/?id=674 Tue, 12 Feb 2008 00:00:00 -0600 The Centers for Medicare and Medicaid Services (CMS) has released the most recent results of the latest Comprehensive Error Rate Testing Program (CERT), and included in the report is a list of the most overutilized codes. Topping the list once again are evaluation and management services. http://www.OptumCoding.com/CodingCircleArticles/?id=669 Tue, 22 Jan 2008 00:00:00 -0600 Although most physician practices perform some type of microscopy service, many do not understand the effects this can have under the Clinical Laboratory Improvement Act (CLIA). http://www.OptumCoding.com/CodingCircleArticles/?id=670 Tue, 22 Jan 2008 00:00:00 -0600 The Centers for Medicare and Medicaid Services (CMS) has updated its national coverage determination (NCD) for erythropoiesis stimulating agents (ESAs) treatment, saying that it is reasonable and necessary for treating anemia secondary to myelosuppressive anticancer chemotherapy in solid tumors, multiple myeloma, lymphoma and lymphocytic leukemia under specified conditions. http://www.OptumCoding.com/CodingCircleArticles/?id=671 Tue, 22 Jan 2008 00:00:00 -0600 The -10.1 percent change to the physician fee schedule conversion factor that was to be effective January 1 through June 30, 2008, has been changed to a 0.5 percent increase. http://www.OptumCoding.com/CodingCircleArticles/?id=666 Tue, 08 Jan 2008 00:00:00 -0600 On January 3rd, 2008, the Centers for Medicare and Medicaid Services (CMS) published a final rule that delays until January 1, 2009, the revised criteria of the anti markup provisions in section 414.50 of the Code of Federal Regulations (CFR). http://www.OptumCoding.com/CodingCircleArticles/?id=667 Tue, 08 Jan 2008 00:00:00 -0600 The Centers for Medicare and Medicaid Services (CMS) has made a number of changes to the standard codes that are used on the remittance advice to tell a provider why a claim was denied or processed differently from how it was submitted. http://www.OptumCoding.com/CodingCircleArticles/?id=668 Tue, 08 Jan 2008 00:00:00 -0600 b http://www.OptumCoding.com/CodingCircleArticles/?id=833 Tue, 01 Jan 2008 00:00:00 -0600 Late December 19th, Congress passed legislation to prevent the negative 10.1 percent update to the physician fee schedule conversion factor and instead, allowed for a 0.5 percent increase. This means that the estimated conversion factor is 37.9165 instead of the 34.0682 published in the final rule. http://www.OptumCoding.com/CodingCircleArticles/?id=663 Wed, 26 Dec 2007 00:00:00 -0600 On the whole, version 14.0 of the National Correct Coding Initiative edits reflect the CPT® changes for 2008. http://www.OptumCoding.com/CodingCircleArticles/?id=664 Wed, 26 Dec 2007 00:00:00 -0600 New criteria for making a code subject to lower payment because of multiple procedures mean that the appropriate reductions will now apply to additional codes. This, in turn, means a reduction in payment and a hit to some providers’ bottom lines. http://www.OptumCoding.com/CodingCircleArticles/?id=665 Wed, 26 Dec 2007 00:00:00 -0600 The Centers for Medicare and Medicaid Services (CMS) published the 2008 final rule on changes to the outpatient prospective payment system (OPPS) in the Federal Register on November 27, 2007. As part of the rule, CMS made the following ambulatory payment classification (APC) reassignments effective January 1, 2008... http://www.OptumCoding.com/CodingCircleArticles/?id=643 Tue, 11 Dec 2007 00:00:00 -0600 The Centers for Medicare and Medicaid Services (CMS) will pay for brachytherapy sources separately on a prospective basis for 2008. As of December 31, 2007, brachytherapy sources will no longer be paid on the basis of their charges adjusted to cost and all codes will be assigned to status indicator K. http://www.OptumCoding.com/CodingCircleArticles/?id=644 Tue, 11 Dec 2007 00:00:00 -0600 The Centers for Medicare and Medicaid Services (CMS) will not recognize new CPT® codes 99408 and 99409 for reporting alcohol and/or substance abuse screening. Medicare does not cover screening services unless specifically mandated by statute, such as has been done for mammography, diabetes, and colorectal cancer screening. http://www.OptumCoding.com/CodingCircleArticles/?id=662 Tue, 11 Dec 2007 00:00:00 -0600 The Centers for Medicare and Medicaid Services (CMS) has decided to create two composite ambulatory payment classifications (APCs) that will provide payment to hospitals in certain circumstances when extended assessment and management of a patient occur. http://www.OptumCoding.com/CodingCircleArticles/?id=640 Tue, 27 Nov 2007 00:00:00 -0600 Effective April 1, 2008, providers will have another place of service (POS) code to choose from. The Centers for Medicare and Medicaid (CMS) has developed new place-of-service code 16 to indicate temporary housing. http://www.OptumCoding.com/CodingCircleArticles/?id=641 Tue, 27 Nov 2007 00:00:00 -0600 A new and a revised discharge status indicator will enable hospitals to report patient status in more detail beginning April 1, 2008. http://www.OptumCoding.com/CodingCircleArticles/?id=642 Tue, 27 Nov 2007 00:00:00 -0600 The final rule for updates to the physician fee schedule isn’t pretty, at least as far as physician payment is concerned. It looks like physicians will see a negative 10.1 percent update in Medicare fee-for-service payment rates unless Congress takes action. http://www.OptumCoding.com/CodingCircleArticles/?id=637 Tue, 13 Nov 2007 00:00:00 -0600 The final rule on the outpatient prospective payment system describes new payment policies and quality measure reporting, and updates the rates for the revised ambulatory surgery center (ASC) payment system. The rule applies to services furnished during calendar year (CY) 2008. http://www.OptumCoding.com/CodingCircleArticles/?id=638 Tue, 13 Nov 2007 00:00:00 -0600 The Physician Quality Reporting Initiative (PQRI) measures for 2008 include an increased number of measures, as well as guidelines for reporting technology enhancements. http://www.OptumCoding.com/CodingCircleArticles/?id=639 Tue, 13 Nov 2007 00:00:00 -0600 Beware—coders must be careful using the new CPT® codes for telephone services because they are assigned depending on provider type. The American Medical Association included the new codes as part of its update for 2008. http://www.OptumCoding.com/CodingCircleArticles/?id=634 Tue, 30 Oct 2007 00:00:00 -0500 Changes to the narrative of CPT® modifiers 22, 25, 32, 51, 58, 59, 76 and 78 clarify when it is appropriate to use the modifiers but do not affect code assignment. There is also one new modifier. http://www.OptumCoding.com/CodingCircleArticles/?id=635 Tue, 30 Oct 2007 00:00:00 -0500 The Centers for Medicare and Medicaid Services (CMS) has instructed contractors to begin rejecting Health Insurance Portability and Accountability Act (HIPAA) inbound claims if they contain legacy provider identifiers beginning January 8, 2008. However, if the shared system analysis work that will occur in January 8, 2008, is not completed, CMS provides an alternate date of April 4, 2008. http://www.OptumCoding.com/CodingCircleArticles/?id=636 Tue, 30 Oct 2007 00:00:00 -0500 The Office of Inspector General (OIG) has released the 2008 workplan, giving providers a peek at what areas OIG and Medicare contractors will scrutinize in the upcoming year for possible errors, fraud and abuse, or potential Medicare savings. http://www.OptumCoding.com/CodingCircleArticles/?id=631 Tue, 16 Oct 2007 00:00:00 -0500 Effective October 1, coding infections due to central venous catheters became more difficult with the creation of new code 999.31. http://www.OptumCoding.com/CodingCircleArticles/?id=632 Tue, 16 Oct 2007 00:00:00 -0500 The Centers for Medicare and Medicaid Services (CMS) has released the final 2007 updates to the Medicare physician fee schedule (MPFS). These updates became effective October 1. http://www.OptumCoding.com/CodingCircleArticles/?id=633 Tue, 16 Oct 2007 00:00:00 -0500 The changes to the CPT® coding system for 2008 will be massive, according to a preview of revisions released by the American Medical Association (AMA). There are more than 500 code changes affecting anesthesia, evaluation and management, radiology, path/lab, category III, and especially surgery, medicine, and category II codes. http://www.OptumCoding.com/CodingCircleArticles/?id=629 Tue, 25 Sep 2007 00:00:00 -0500 Medicare severity-adjusted diagnosis-related groups (MS-DRGs) will be implemented for discharges occurring on or after October 1, 2007, as was announced in the inpatient prospective payment system (IPPS) final rule (CMS-1533-FC). http://www.OptumCoding.com/CodingCircleArticles/?id=628 Tue, 25 Sep 2007 00:00:00 -0500 In the past week, the Centers for Medicare and Medicaid Services (CMS) has released or revised three national coverage determinations (NCDs). NCDs are the coverage policies all Medicare contractors must follow when processing Medicare claims. Information about each can be found below. http://www.OptumCoding.com/CodingCircleArticles/?id=630 Tue, 25 Sep 2007 00:00:00 -0500 Effective October 1, 2007, all claims submitted to Medicare Part A contractors must contain a present-on-admission (POA) indicator for every diagnosis on acute care hospital claims. Critical access hospitals, Maryland waiver, long-term care, cancer, and psychiatric hospitals, as well as inpatient rehabilitation and children’s inpatient facilities are exempt from this requirement. http://www.OptumCoding.com/CodingCircleArticles/?id=625 Tue, 11 Sep 2007 00:00:00 -0500 The National Plan and Provider Enumeration System (NPPES) data on health care providers that is disclosable under the Freedom of Information Act (FOIA) will be disclosed to the public by the Centers for Medicare & Medicaid Services (CMS). http://www.OptumCoding.com/CodingCircleArticles/?id=626 Tue, 11 Sep 2007 00:00:00 -0500 To protect Medicare patients from fraudulent providers of infusion therapy, Health and Human Services Secretary Mike Leavitt announced a two-year initiative that will focus on deterring deceptive practices. http://www.OptumCoding.com/CodingCircleArticles/?id=627 Tue, 11 Sep 2007 00:00:00 -0500