Posts tagged ‘2012’

April 19, 2012

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:

  • 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

March 19, 2012

5010 enforcement moves to June 30

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.

November 21, 2011

CMS will enforce 5010 standards in April

The Centers for Medicare & Medicaid Services’ Office of E-Health Standards and Services (OESS) will not initiate enforcement action with respect to any HIPAA covered entity non-compliant with the ASC X12 Version 5010 (Version 5010), NCPDP Telecom D.0 (NCPDP D.0) and NCPDP Medicaid Subrogation 3.0 (NCPDP 3.0) standards until 90 days after their January 1, 2012 compliance date, or until March 31, 2012.

The compliance date for implementation of these updated standards remains January 1, 2012.

Look at the Latest News page of the ICD-10 website.

November 14, 2011

Jan. 1 M0090 date is the end for case-mix hypertension

CMS has clarified that payment changes relative to the removal of the hypertension codes will be effective with M0090 dates of 1/1/2012.

“Beginning with M0090 dates of January 1, 2012, 401.1 Benign essential hypertension codes and 401.9 Unspecified essential hypertension are removed from the HH PPS case-mix system. Specifically, 401.1 and 401.9 diagnosis codes will no longer result in additional points when computing the HIPPS codes”

Providers should not change the codes they use for hypertension unless they have been coding the 401 codes in error. Changing the codes just to get points is upcoding and we certainly do not want to prove CMS correct about case mix creep. You can be sure that they will be watching for trends in hypertension coding as a result of the case mix change.

Remember hypertension with chronic kidney disease (585) or renal sclerosis (587) changes the hypertension code to the 403 category. There is a presumed relationship between CKD and HTN with HTN causing the CKD.

However, a relationship between heart disease and HTN cannot be presumed. The physician must either state (e.g., heart failure due to hypertension) or imply the relationship (e.g., hypertensive heart disease).

Even if you do not have the information to be able to change the hypertension code to some other category besides 401, do not despair! Remember that hypertension and heart disease are together in Table 4. Even if you do not earn points with the hypertension codes, think how many of your patients with 401 codes also have codes from the 414 category (coronary atherosclerosis and chronic ischemia), 410 (acute myocardial infarction) and 428 (heart failure). Those codes are case mix, too, so you will not be losing any points!

Grouper information!