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.

Read more »

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.

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.

Read more »

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 »

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.

Read more »

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 »

In reviewing the criteria required for Certification Commission for Health Information Technology (CCHIT) credentialing, the American Academy of Professional Coders (AAPC) uncovered multiple areas for concern. Many of the CCHIT requirements conflict with federal mandates for correct coding or with what AAPC promotes as appropriate coding principals.  Read more »

Long-discussed reconsideration of F-18 fluoro-D-glucose (FDG) positron emission tomography (PET) scanning of solid tumors and myelomas has been completed by the Centers for the Medicare & Medicaid Services (CMS). The changes, to be implemented Oct. 30 and retroactively effective to April 3, are extensive.

Read more »

By Deborah Grider, CPC, CPC-I, CPC-H, CPC-P, CEMC, COBGC, CPCD, CCS-P

Is your organization delaying the implementation process.  Do you feel like the federal government will delay ICD-10 so you are procrastinating beginning the process? Are you risking delay and in some cases lost revenue in 2013?  ICD-10 seems like a long time away, but is it? Read more »