Recovery Audit Contractors (RAC) HealthDataInsights (HDI) and CGI Federal have added to their list of new issues eligible for review as per the Centers for Medicare & Medicaid Services (CMS).

The RAC program, mandated by the Tax Relief and Health Care Act of 2006, is being implemented in 2010 to detect and correct past improper Medicare payments.

Tip: Don’t wait until Jan. 1, 2010 to review these new issues and correct any problems your outpatient hospital or physician practice may uncover. Read more »

The Centers for Medicare & Medicaid Services (CMS) began accepting bids for the Round One Rebid of the Medicare Competitive Bidding Program for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) on Oct. 21. Qualified DME suppliers in nine areas have until Dec. 21 to submit bids.

Registration to participate in the Round One Rebid is nearing an end. Suppliers that wish to submit bids must be registered by Nov. 4, 9 p.m. EST.

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The annual update to the clotting factor furnishing fee is $0.170 per I.U. and is effective from Jan. 1, 2010 to Dec. 31, 2010. This fee is included in the published payment limit for HCPCS Level II clotting factor billing codes (J7189-J7195) and added to the payment for a clotting factor when no payment limit is published either on the Average Sales Price (ASP) Medicare Part B Drug Pricing File or the Not Otherwise Classified (NOC) Pricing File.

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Want to increase the number of claims that successfully complete processing and enhance a positive cash flow? Heed Noridian Administrative Services’ (NAS) advice. The Medicare administrative contractor (B/MAC) has identified its top five denials for the months of July, August, and September and offers solutions and resources. Read more »

Hospitals who successfully participated in quality data reporting for outpatient services will receive a 2.1 percent inflation update in their 2010 payment rates for services furnished to Medicare beneficiaries in outpatient departments, according to the Centers for Medicare & Medicaid Services (CMS). Ambulatory surgical centers (ASCs) will receive a 1.2 percent inflation update beginning Jan. 1, 2010 using the same payment methodology as in 2009.

These and other payment and policy changes can be found in the 2010 Hospital Outpatient Prospective Payment System (OPPS) and ASC final rule with comment period — put on display for review Oct. 30.

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The 2010 payment limits for splints and casts will be based on 2009 payment limits. Due to a -1.41 percent change in the consumer price index for all urban consumers (CPI-U) for the 12-month period ending June 2009, the inflation indexed charge (IIC) update factor for 2010 is 0 percent. Read more »

The Centers for Medicare & Medicaid Services (CMS) has determined that its blanket of non-coverage for blood flow measurement using magnetic resonance imaging (MRI) technology contradicts its policies and magnetic resonance angiography (MRA). CMS has eliminated that from the national coverage determination (NCD), effective Sept. 28, and is allowing payers to choose to cover the services.  This will impact four codes in January’s outpatient code editor (OCE).

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Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) added new mandatory reporting requirements for group health plans (GHP) and non-group health plans (NGHP), such as liability insurance (including self-insurance), no-fault insurance, and workers’ compensation.

The implementation dates for most casualty insurers have come and gone, but there’s still time for compliance.

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The Centers for Medicare & Medicaid Services (CMS) updated, Oct. 14, its Medicare Fee-for-Service (FFS) Q&As to address H1N1-related questions circling among the health care industry. Read more »

The Centers for Medicare & Medicaid Services (CMS) announced, Oct. 30, final changes to 2010 Medicare Physician Fee Schedule (MPFS) policies and payment rates. Taking into account all changes in the final rule, CMS projects a payment increase between 5 and 8 percent for health care professionals paid under the MPFS. That’s the good news …

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