Govt: Medicare Paid $47 Billion in Suspect ClaimsThe 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."
AHIMA RELEASES HEALTH During the 81st Annual Convention and Exhibit, AHIMA released their 7-point Bill of Rights, "A Model for Protecting Americans' Health Information Principles."
AHIMA REGISTRATION It's not too late to register! 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, 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: HCCA publishes a website dedicated For information concerning the May 5 audio conference overview, faculty list, agenda, and registration, click here.
CMS RAC PROVIDER OUTREACH 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."
ICD-10-CM FINAL RULE 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."
RAC Update CMS released the January 2009 "Update 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."
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."
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."
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.
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 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
|
Healthcare News Feed |