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."
CMS Manual System Transmittal SUBJECT: July 2008 Update of the Hospital Outpatient Prospective Payment System (OPPS) New / Revised Material
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."
CMS 2/25/08 HIPPA 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."
Update to Place of Service "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 "This document corrects Click here for access to the Federal Register PDF file.
79th AHIMA Convention and Exhibit Thanks for visiting us at AHIMA. If we scanned your badge, you may have won one of our booth prizes. Check our winner's list on the website.
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.
UB-04 Fact Sheet Available The May 2007 Fact Sheet, Implementation of the UB-04, is available on the CMS website, General Medicare Program Information, MLN Publications. Beginning May 23, 2007, all providers eligible to submit paper claims must use the new UB-04 form. The 'about' page describes the document, available as a PDF, as follows:
The UB-04 incorporates the NPI, and provides for both nine and ten digit codes which will accommodate lengthier ICD-10 codes, plus additional updates. The Fact Sheet includes a "crosswalk" table which compares the UB-92 to the UB-04. Click here to download the Fact Sheet in PDF format.
CMS to Better Account for 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
AHIMA Approves Changes to Membership Categories At the 78th Annual Convention in Denver, the House of Delegates met to discuss important issues facing the HIM profession. Among the changes approved was consolidation of the CHP and CHS credentials. To read more about the meeting, visit the AHIMA website. Read more about the DoD Meeting.
|
Healthcare News Feed |