April 19, 2012
You can read the proposed rule to delay ICD-10 until Oct. 1, 2014.
CMS has released a fact sheet outlining the proposed rule.
The comment period closes at 5pm ET on May 17.
To submit comments:
The 30-day comment period for this rule is an important way to provide feedback to HHS about the proposed ICD-10 compliance date change. You can submit comments in the following ways:
- Electronically by following the ‘‘Submit a comment’’ instructions on Regulations.gov
- By regular mail to:
Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS–0040–P
P.O. Box 8013
Baltimore, MD 21244–8013
Posted in News! |
Leave a Comment »
April 17, 2012
CMS to focus on 2 new areas for reviews
At the NAHC conference in Washington, DC, recently, Latesha Walker of CMS said that CMS will begin medical reviews in two new areas:
- Episodes that barely exceed the low utilization payment adjustment (LUPA) threshold of five visits with document reviews.
- Review situations where an agency billed a low HHRG code for a first episode, but a higher one later.
Just because there are two new additions doesn’t mean that the old reviews shouldn’t be paid attention to anymore!
A few other things discussed at the meeting:
- CMS has already set a 1.32 percent cut for case-mix in 2013 because of case-mix creep. CMS is moving ahead with its PPS rebasing project.
- Confused on assessments and billability of visits with therapy? You’re not the only one. NAHC is still asking for clarification on when an assessment visit is billable (ever?) what is billable if you don’t do the assessment at exactly 30 days or the 13th or 19th visit. What if it’s the 14th visit? When does a visit become billable?
- New CoP? Really? We’ll believe it when we see it, but Pat Sevast said new Conditions of Participation are on CMS’s to-do list.
Thanks, again, to HCLA for its update in its News Alert!
Posted in News! |
Leave a Comment »
April 9, 2012
Despite what you may have read, ICD-10-CM is NOT delayed until October 1, 2014!!
CMS proposed to move the implementation date to October 1, 2014. The healthcare industry has the opportunity to comment on the proposal and THEN CMS can publish a final rule.
CMS estimates that a delay in implementation will cost health care entities, including state Medicaid systems, $1 billion to $6.5 billion.
There are certain to be numerous comments both for the delay and for implementation as was required in the 2009 final rule. Only time will tell.
Posted in News! |
Leave a Comment »
April 9, 2012
HHS is proposing a rule to delay ICD-10 implementation until Oct. 1, 2014.
The new date is part of a proposed rule that would adopt a standard for a unique health plan identifier (HPID), adopt a data element that would serve as an “other entity” identifier (OEID), and add a National Provider Identifier (NPI) requirement.
Here is the press release.
The proposed rule is CMS-0040-P and you can see it at the Federal Registrar website.
Posted in News! |
Leave a Comment »
April 6, 2012
Thanks to HCLA for letting us know a little about what was said at the recent NAHC conference in Washington DC. A CMS representative said a new OASIS … C-1 … is in the works.
Pat Sevast of CMS said the revisions are centered about the switch to ICD-10 coding.
While CMS has announced a delay to the implementation of ICD-10, “we are proceeding as if ICD-10 is going to be implemented Oct. 1, 2013,” she said. That’s because CMS’s delay for the new coding set won’t be official until it finishes rulemaking.
|
|
|
|
Posted in News!, OASIS |
Leave a Comment »
April 1, 2012
We hear a lot about remote health work and monitoring, and it seems to work really well at times. This caught my eye because it’s an experiment in monitoring COPD, which can be so tricky, as we all know!
The University of California Los Angeles (UCLA) and eResearchTechnology, Inc. (ERT) want to work together to identify COPD symptoms early on, specifically in a remote health setting, to provide better care outside a physician’s office. They also want to see if technology can detect potential exacerbation.
The randomized study will test home-based spirometry, activity monitoring, adherence scoring, and self-reported symptom monitoring. A web-based data tracking site will analyze patient data to look for trends in symptoms and concerns.
The most popular remote monitoring right now is for cardiac patients and insurers (some!) have begun to pay for the monitoring.
Learn about the partnership.
Posted in News! |
Leave a Comment »
March 28, 2012
I don’t know why I’ve had people ask me lately if you can reverse pressure ulcer stages for Stage I and II ulcers, but you can’t, and CMS has clarified M1324 in a recent Q&A.
CMS also clarified an M1307 question dealing with a pressure ulcer that progressed from Stage I to Stage II during the episode:
Question: If the patient had a Stage I pressure ulcer at SOC that progressed to a Stage II, how do we answer M1307 at discharge?
CMS Answer: If a patient had a Stage I pressure ulcer at SOC/ROC and it advanced to a Stage II by discharge, Response “1-Was present at the most recent SOC/ROC assessment” would be appropriate due to the fact that the ulcer, caused by pressure, was present at the most recent SOC/ROC assessment, even though it was a Stage I at that time.
Looking for more CMS answers?
Posted in News!, OASIS |
Leave a Comment »
March 26, 2012
The HHS Office of the Inspector General conducted a study looking at home health claims from 2002-2008 and found that$432 million in Medicare monies were inappropriately paid either because medical necessity was not established or coding was inaccurate. Millions more dollars were lost to CMS or HHAs because of upcoding or downcoding.
The number of HHAs grew from 7,052 to 9,801, and increase of 39 percent. Medicare spending on home health increased 84 percent from $8.5 billion in 2000 to $15.7 billion in 2007. The sharp rise in payments created the push to investigate payments.
HHS reviewed the claims of almost 500 beneficiaries to see whether Medicare coverage requirements were met.
The office found that 22 percent of claims were in error because services were not medically necessary or claims were coded inaccurately, resulting in $432 million in improper Medicare payments. Also, HHAs upcoded about 10 percent ($278 million) of claims and downcoded about 10 percent ($184 million) of claims.
OIG believes it needs to investigate more to determine what services are met and what potential for fraud is involved.
Read the complete report.
Posted in ICD-9 Coding, News! |
Leave a Comment »
March 19, 2012
Sorry! I forgot to hit “publish” on this post from last week!
From CMS …
In an announcement, the Centers for Medicare & Medicaid Services’ (CMS) Office of E-Health Standards and Services (OESS) said it will not initiate enforcement action against any non-compliant entities for an additional three (3) months, through June 30, 2012, for updated HIPAA transaction standards (ASC X12 Version 5010, NCPDP Versions D.0 and 3.0).
…
Health plans, clearinghouses, providers and software vendors have been making steady progress: the Medicare Fee-for-Service (FFS) program is currently reporting successful receipt and processing of over 70 percent of all Part A claims and over 90 percent of all Part B claims in the Version 5010 format. Commercial plans are reporting similar numbers. State Medicaid agencies are showing progress as well, and some have made a full transition to Version 5010.
Posted in News! |
Leave a Comment »
March 14, 2012
From the Centers for Disease Control and Prevention …
The rate of leg and foot amputations among U.S. adults aged 40 years and older with diagnosed diabetes declined by 65% between 1996 and 2008, according to a new study by the Centers for Disease Control and Prevention (CDC).
The CDC attributes better blood glucose control, foot care, and diabetes management, along with a drop in heart disease, as likely reasons that the number of amputations has fallen.
Diabetes is the leading cause of nontraumatic amputations of feet and legs among U.S. adults.
The age-adjusted rate of nontraumatic lower-limb amputations was 3.9 per 1,000 people with diagnosed diabetes in 2008 compared to 11.2 per 1,000 in 1996.
To learn more, go to the CDC site on diabetes.
Posted in News! |
Leave a Comment »
Comment period on potential ICD-10 delay is now open
You can read the proposed rule to delay ICD-10 until Oct. 1, 2014.
CMS has released a fact sheet outlining the proposed rule.
The comment period closes at 5pm ET on May 17.
To submit comments:
The 30-day comment period for this rule is an important way to provide feedback to HHS about the proposed ICD-10 compliance date change. You can submit comments in the following ways:
Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS–0040–P
P.O. Box 8013
Baltimore, MD 21244–8013
Posted in News! | Leave a Comment »