RAC Documentation Modification
Set by CMS
CMS released an update explaining the modification to additional documentation request limits for the RAC program. The FY 2010 modifications apply to institutional providers.
Read the CMS update.
~~~
AHIMA Interviews New CEO
AHIMA has published a YouTube video of their Q&A with incoming CEO, Dr. Alan Dowling, who took office on January 13, 2010.
Watch the Video.
~~~
What's Your RAC IQ?
In their online newsmagazine, ADVANCE for HIM Professionals invites you to
Test your knowledge about the audit program.
Cheryl McEvoy, editorial assistant, presents the 15-question RAC Quiz.
~~~
Non-Profit Launches Health
Information 'Do Not Disclose' List
Patient Privacy Rights, a non-profit 501(c)3 organization, offers online pre-registration leading up to the official Do Not Disclose site. The mission statement on their Web site includes the following:
"Our mission is to ensure the right to control your medical privacy,
to protect your jobs and opportunities."
According to their Web site, the group is supported by individuals and does not receive funding from any corporations or health IT organizations.
Access the PPR site here.
~~~
Interview With New Chair-Elect of
American Hospital Association
The December 11, 2009, HHN Digital Magazine features an interview with the new AHA Chair-Elect. The following is an excerpt of John Bluford's comments to Mary Grayson, Publisher of AHA's Health Forum. Mr. Bluford is the president and CEO of Truman Medical Centers, Kansas City, Missouri. See the link below to read the entire article.
"A theme in this year's discussions is that hospital environments with employed physicians, such as Mayo and the Cleveland Clinic, have better continuity of care, better results and run more efficiently and effectively. The physicians and the hospital are not working at cross purposes with cross incentives. In most institutions, the hospital and the physicians are legally independent organizations, but they are connected at the hip financially; one can't move successfully without the other. The new world order through health care reform with strong disease management, bundled payments and gainsharing arrangements should lead us in more unified alignment."
Read HHN article.
~~~
AHIMA Board Announces
Next Chief Executive
With current CEO Linda Kloss' retirement announcement in July 2009 came AHIMAs duty to find her successor.
They have chosen university professor Alan F. Dowling, Ph.D., to head the 55,000-member association. Dr. Dowling will assume office on January 13, 2010.
Read the press release.
~~~
Govt: Medicare Paid $47 Billion in Suspect Claims
The AP reports on a new government study showing a dramatic increase in improper Medicare claims and payments. Recently, HHS has indicated it is increasing its number of agents and prosecutors tenfold.
According to AP, "Officials say they also want to increase training and outreach among Medicare providers to reduce documentation errors, while proposed health overhaul legislation would increase background checks on Medicare claimants and impose stiffer penalties for false claims."
Read the AP story.
~~~
AHIMA RELEASES HEALTH
INFORMATION BILL OF RIGHTS
AT THE NATIONAL CONVENTION
During the 81st Annual Convention and Exhibit, AHIMA released their 7-point Bill of Rights, "A Model for Protecting Americans' Health Information Principles."
Cheryl McEvoy, editor of Advance for Health Information Professionals, covered the unveiling in her online blog, "ADVANCE Perspective: HIM."
Access the blog here.
~~~
AHIMA REGISTRATION
It's not too late to register!
The 81st AHIMA Convention and Exhibit will be held at the Gaylord Texan Resort and Convention Center located at 1501 Gaylord Trail, Grapevine, TX, 76051.
Go to convention registration page.
~~~
HEALTH POLICY BRIEF
Health Affairs, The Policy Journal of the Health Sphere, digests "Key Issues in Health Reform" in its August 20, 2009, Health Policy Brief. The briefs are produced by Health Affairs with the support of a
grant from the Robert Wood Johnson
Foundation.
Read the Health Policy Brief here.
~~~
SECOND MEDICARE RAC SUMMIT
The second national RAC Summit will take place September 14-15, 2009, onsite at the Wardman Park Hotel, Washington, DC. The Summit webcast can be viewed online live, and archives will be accessible for six months.
Access the RAC Summit website here.
~~~
CMS ISSUES PROPOSED RULE,
‘COMMENTS DUE’ DATE
CMS has published the following in the Federal Register:
"Proposed Changes to the Hospital Inpatient Prospective
Payment Systems for Acute Care Hospitals and Fiscal Year 2010 Rates and to the
Long-Term Care Hospital Prospective Payment System and Rate Year 2010 Rates"
To meet the scheduled deadline, interested parties must submit comments no later than 5 p.m. E.S.T. on June 30, 2009.
Click here to access the Federal Register
~~~
HCCA AUDIOCONFERENCE WEBSITE:
RAC AUDIT APPEALS
HCCA publishes a website dedicated
to the National Healthcare Compliance Audioconference: "
RAC Audit Appeals - Strategies and Defenses for Overturning Hospital RAC Denials."
For information concerning the May 5 audio
conference overview, faculty list,
agenda, and registration, click here.
~~~
CMS RAC PROVIDER OUTREACH
SCHEDULE POSTED
The new RAC Provider Outreach Schedule provides the dates and times of various outreach sessions for RAC regions A-D. CMS reports that it intends to update the schedule as more sessions are scheduled.
CMS has promised to make outreach programs available to providers to familiarize them with their policies and contact information. Watch here for more information on these town hall meetings.
~~~
RAC STOP WORK ORDER LIFTED
"On February 4, 2009 the parties involved in the protest of the award of the Recovery Audit Contractor (RAC) contracts settled the protests. The settlement means that the stop work order has been lifted and CMS will now continue with the implementation of the RAC program."
Read the CMS report detailing the implementation and expansion of the program, including the names of the national Recovery Audit Contractors selected by RFP, map of future jurisdictions, and expansion schedule.
~~~
ICD-10-CM FINAL RULE
IMPLEMENTATION DATE SET
On January 15, 2009, HHS announced the final regulation
to replace the ICD-9-CM code sets now used to report healthcare diagnoses
and inpatient procedures with the more advanced ICD-10 code set. A copy
of the Federal Register Online can be viewed via GPO Access.
"The compliance date, which is different than the effective
date, is the date on which entities are required to have implemented
the policies adopted in this rule. The compliance date for this regulation
is October 1, 2013."
Click to access Rule
~~~
RAC Update
CMS released the January 2009 "Update
to the Evaluation of the
3-Year Demonstration" as relates to "The Medicare
Recovery Audit Contractor
(RAC)
Program." Results of the RAC demonstration through August 31, 2008, show
$1.03 billion in improper Medicare payments, of which 96% were overpayments
and 4% underpayments.
CMS intends to prevent future improper payments, stating
in the report: "Hospitals and other health care providers can use this
information to help ensure that they are submitting correctly coded claims
for services that meet Medicare’s coding and medical necessity policies."
Read CMS Update
~~~
The Centers for Medicare & Medicaid Services
(CMS) ICD-10 Planning: AHIMA Report
"The data represent the impacts of ICD-10 on affected business
functional areas, operations, policies, processes, and systems. The report
findings include an assessment of the Nature of the Impacts, Implementation
Risks, Interdependencies, Cost Estimates and Recommendations."
Read ICD-10 Report
~~~
ICD-10-CM/PCS National Provider Conference
Call
The transcript of the Centers for Medicare & Medicaid
Services ICD-10-CM/PCS National Provider Conference Call for Other Part
A and Part B Providers, held on November 12, 2008, is now available.
Excerpt: "Slide 11 discusses the benefits of adopting a
new procedure coding system. First, it would incorporate greater specificity
and more clinical information, and this would result in improving our
ability to measure healthcare services. It would increase sensitivity
when we’re refining groupings and reimbursement methodologies such as
MS-DRGs. It would enhance the ability to conduct public health surveillance,
and it would also decrease the need to include supporting documentation
with claims."
Click to go to Transcript
~~~
The Medicare Recovery Audit Contractor
(RAC) Program Evaluation
This report presents an evaluation of the Medicare
RAC demonstration from its inception in 2005
through March 27, 2008.
Excerpt from Introduction: "There has been
a growing concern that, even with all these efforts, the Medicare Trust
Funds may not
be adequately protected against improper payments.
Accordingly, Congress took action by passing
legislation to enhance and support Medicare’s
current efforts in identifying and correcting improper
payments. In Section 306 of the MMA, Congress
directed the DHHS to conduct a 3-year demonstration
using RACs to detect and correct
improper payments in the Medicare FFS program
(see Appendix A). Later, in Section 302 of the
TRHCA, Congress required the DHHS to make the
RAC program permanent and nationwide by no
later than January 1, 2010."
Click to go to CMS Report
~~~
CMS Manual System Transmittal
SUBJECT:
July 2008 Update of the Hospital
Outpatient Prospective Payment System (OPPS)
New / Revised Material
Effective Date: July 1, 2008
Implementation Date: July 7, 2008
Link to Transmittal
~~~
Critical Access Hospitals
Per CMS: "The April 2008 version
of the Critical
Access Hospital Fact Sheet is now available in downloadable format
from the Centers for Medicare & Medicaid Services.
The fact sheet provides information about eligible Critical
Access Hospital (CAH) providers; CAH designation; CAH payments; reasonable
cost payment principles that do not apply to CAHs; election of Standard
Method or Optional (Elective) Payment Method; Medicare Rural Pass-Through
funding for certain anesthesia services; Health Professional Shortage
Area Incentive payments; Physician Scarcity Area Bonus payments; Medicare
Prescription Drug, Improvement, and Modernization Act of 2003; and grants
to states under the Medicare Rural Hospital Flexibility Program."
Click
to access Fact Sheet
~~~
CMS 2/25/08 HIPPA
Outreach Email Update
"New HIPAA Security
Information
on the CMS website"
CMS released an email update concerning what providers should
expect during onsite compliance reviews. In part, the description reads,
" . . . OESS recently procured contracted services to assist with onsite
compliance reviews related to potential HIPAA Security Rule violations."
Access
CMS Memo Here
~~~
Update to Place of Service
(POS) Code Set
"Effective for claims initiated on or after April 1, 2008,
CMS is adding to the POS code set a new code for temporary lodging, “16,”
and Medicare is preparing its systems to accept and adjudicate professional
claims with this code when it is in effect. Under HIPAA, the effective
date for nonmedical data code sets, of which the POS code set is one,
is the code set in effect the date the transaction is initiated. It is
not date of service."
Click
here for access to Medicare Learning Network Release.
~ ~ ~
Medicare Program; Changes to the
Hospital Inpatient Prospective Payment
Systems and Fiscal Year 2008 Rates;
Correction; Final Rule
"This document corrects
technical errors that appeared in the
final rule with comment period entitled
'Medicare Program; Changes to the
Hospital Inpatient Prospective Payment
Systems and Fiscal Year 2008 Rates'
that appeared in the August 22, 2007
Federal Register."
Click here for access to the Federal Register PDF file.
~ ~ ~
CMS Recovery Audit Project
The Centers for Medicare and Medicaid Services
have implemented a new demonstration project using recovery audit contractors
to search for improper Medicare payments that may have been made to healthcare
providers. They will begin work on claims that are
at least one year old. The project is part of CMS' further
efforts to uncover inaccurate payments not detected through other existing
program integrity efforts.
Read the CMS
press release concerning the demonstration
project.
Find out how
LMS can help you prepare for the CMS Recovery
Audit.
~ ~ ~
CMS to Better Account for
Severity of Illness
For FY2007, CMS will implement limited DRG modifications
as a preliminary improvement in accounting for severity of illness.
The changes harbinger significant strides planned for FY2008.
"CMS identified 20 new DRGs involving 13 different
clinical areas that would significantly improve the CMS DRG system’s
recognition of severity of illness."
Read
more about the FY2007
PPS Final Rule in CMS Fact Sheet.
~ ~ ~
|
