Posts tagged ‘HHS’

November 16, 2012

Nephrostomy tubes are response 2 on M1018

A clarification from CMS on M1018 and nephrostomy tubes …

Question: When answering M1018, if client has a nephrostomy tube do you mark indwelling/suprapubic catheter?
Answer from CMS: If the nephrostomy tube is utilized for urinary drainage, it is an indwelling
catheter, therefore Response 2 – Indwelling/suprapubic catheter would be selected.
See more Q&As.

May 8, 2012

ICD-10 comment period to close soon

Just a reminder that the comment period on potentially delaying ICD-10 from Oct. 1, 2013, to Oct. 1, 2014, closes May 17 at 5pm EDT.

See the proposed rule.

Get your comments in:

Electronically by following the ‘‘Submit a comment’’ instructions on the

By regular mail:

Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS–0040–P
P.O. Box 8013
Baltimore, MD 21244–8013

April 9, 2012

HHS proposes delay of ICD-10 until 2014

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.


March 26, 2012

OIG finds $432 million+ in HHA claims issues

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.

February 24, 2012

10 for 10

I looked at this communication from AHIMA and thought “This is good!” Fight for ICD-10!


AHIMA members,

We appreciate your continued support and willingness to help us communicate the detriment to the healthcare industry should ICD-10 be delayed. AHIMA stands strong with its position to “stay the course” and continue to plan and prepare for the ICD-10 transition.

Many of you have asked what you can do and say to help support the mission to not delay ICD-10. It’s important for all of us to talk from one, unified voice. To assist us in that goal, AHIMA has developed a list—“Ten for 10: Top Ten Reasons We Need ICD-10 Now.” We encourage you to use these messages and add your personal experiences to show real life examples of how an ICD-10 delay would greatly impact progress and resources that have already been invested in the transition. One of the first places we need to speak up is in the organization where we are employed. Already, surveys are being taken by employer associations like the American Hospital Association and other employers, both providers and health plans, to determine readiness. We need to be ready for ICD-10 and our individual organizations need to continue to work toward compliance on October 1, 2013. We need you and your employer to tell HHS and others of this commitment in order to back up our message of no delay and continued implementation. Besides the Ten for 10 below there is much more information on the AHIMA ICD-10 webpage. Use this information and keep watching for messages via the e-Alert as well as from your state association or delegates.

Thank you again for your continued commitment to advance HIM and your dedication to AHIMA. We will keep you up to date as we move forward.

Lynne Thomas Gordon, CEO, MBA, RHIA, FACHE

Ten for 10: Top Ten Reasons We Need ICD-10 Now

  1. It Enhances Quality Measures.  Without ICD-10 data, serious gaps will remain in the healthcare community’s ability to extract important patient health information needed for physicians and others to measure quality care.
  2. Research Capabilities Will Improve Patient Care. Data could be used in a more meaningful way to enable better understanding of complications, better design of clinically robust algorithms, and better tracking of the outcomes of care. Greater detail offers the ability to discover previously-unrecognized relationships or uncover phenomenon such as incipient epidemics early.
  3. Significant Progress Has Already Been Made.  For several years, hospitals and healthcare systems, health plans, vendors and academic institutions have been preparing in good faith to put systems in place to transition to ICD-10. A delay would cause an unnecessary setback.
  4. Education Programs Are Underway.  To ready the next generation of HIM professionals, academic institutions have set their curriculum for two-year, four-year, and graduate programs to include ICD-10.
  5. Other Healthcare Initiatives Need ICD-10.  ICD-10 is the foundation needed to support other national healthcare initiatives such as meaningful use, value-based purchasing, payment reform, quality reporting and accountable care organizations. Electronic health record systems being adopted today are ICD-10 compatible. Without ICD-10, the value of these other efforts is greatly diminished.
  6. It Reduces Fraud.  With ICD-10, the detail of health procedures will be easier to track, reducing opportunities for unscrupulous practitioners to cheat the system.
  7. It Promotes Cost Effectiveness.  More accurate information will reduce waste, lead to more accurate reimbursement and help ensure that healthcare dollars are used efficiently.

If ICD-10 Is Delayed:

  1. Resources Will Be Lost.  For the last three years, the healthcare community has invested millions of dollars analyzing their systems, aligning resources and training staff for the ICD-10 transition.
  1. Costs Will Increase.  A delay will cause increased implementation costs, as many healthcare providers and health plans will need to maintain two systems (ICD-9 and ICD-10). Delaying ICD-10 increases the cost of keeping personnel trained and prepared for the transition. Other systems, business processes, and operational elements also will need upgrading. More resources will be needed to repeat some implementation activities if ICD-10 is delayed.
  2. Jobs Will Be Lost.  To prepare for the transition, many hospitals and healthcare providers have hired additional staff whose jobs will be affected if ICD-10 is delayed.

And Finally…

We Can’t Wait for ICD-11.  The foundations of ICD-11 rest on ICD-10 and the foundation must be laid before a solid structure can be built. ICD-11 will require the development and integration of a new clinical modification system. Even under ideal circumstances, ICD-11 is still several years away from being ready for implementation in the United States.