Providers need to report all services from October 1 forward with ICD-10 codes, but many will likely face scenarios with patients whose dates of service begin prior to October 1 and end after implementation. CMS has released special guidance to clarify how those instances would be billed with each bill type in MLN Matters ® SE1325 .

CMS has released a transcript and recording of its August 27 MLN Connects Call featuring ICD-10 coding guidance and the results of CMS’ final round of end-to-end testing.

CMS continued its focus on improving the quality of patient care in the fiscal year (FY) 2016 IPPS final rule, released July 31.

The 2016 OPPS proposed rule released July 2 is deceptively short, but packs a punch. CMS is proposing the most massive APC reconfiguration and consolidation of APC groups since the beginning of OPPS, says Jugna Shah, MPH, president and founder of Nimitt Consulting, based in Washington, D.C., and Spicer, Minnesota.

The 2016 OPPS proposed rule introduces APC restructuring, new comprehensive APCs, and many other potential changes for next year. Jugna Shah, MPH, and Debbie Mackaman, RHIA, CPCO, CCDS, review the proposals and what they could mean for providers.

We’re 43 (calendar) days from ICD-10 implementation. We’ve only got 31 working days until October 1. If you are all set for ICD-10, you’re probably fine tuning your coding and documentation, maybe...

CMS has released a document to clarify questions providers raised about its recent guidance on ICD-10-CM, including answers on how the agency is defining a family of codes.

Although CMS did not propose any changes to the 2-midnight rule in the fiscal year 2016 IPPS proposed rule, it signaled its intention to address short stays in the calendar year (CY) 2016 OPPS proposed rule. CMS followed through by introducing several proposed changes to the 2-midnight rule.

A recent salary survey conducted by our sister publication Medical Records Briefing found the same trends prevail year after year: the 145 HIM professionals who responded feel they are overworked and underpaid.

CMS and the American Medical Association (AMA) may have made peace regarding ICD-10, but it seems some members of Congress didn’t get the memo. Reps. Marsha Blackburn, R-Tenn., and Tom E. Price, R-Ga...

CMS continues to move toward increased packaging with its policies in the 2016 OPPS proposed rule released July 2, with additional comprehensive APCs (C-APC) and extensive APC reconfigurations.

A survey conducted in May and June 2015 found providers have completed many steps toward ICD-10 implementation, but lag behind in testing and expect to continue managing the impact after the deadline.

A Comprehensive Error Rate Testing (CERT) study found that the improper payment rate for radiation therapy planning claims was significantly higher than many other physician specialty services, according to the Medicare Quarterly Compliance Newsletter .

The Office of Inspector General (OIG) cited numerous investigations into healthcare as part of its semiannual report to Congress .

CMS declared its second week of ICD-10 end-to-end testing , held from April 27 through May 1, a success. Approximately 875 participants submitted 23,138 test claims during the week and CMS accepted...

A Comprehensive Error Rate Testing (CERT) contractor special study found improper payments on Medicare Part B claims including HCPCS code 84999 (unlisted chemistry procedure) submitted from October to December 2013, according to the latest Medicare Quarterly Compliance Newsletter .

Providers have one last chance to volunteer for ICD-10 end-to-end testing, with CMS extending the deadline to sign up for the July testing period through May 22.

CMS released updated I/OCE specifications in January with several changes that could require providers to examine claims submitted early in 2015 that include comprehensive APCs (C-APC) to ensure proper payment.

Dave Fee, MBA, identifies updates to CMS' programming logic for comprehensive APCs and provides a step-by-step approach to determine whether a complexity adjustment will be applied.

A Comprehensive Error Rate Testing (CERT) study of transcatheter aortic valve replacement/implantation (TAVR/TAVI) services found that approximately one third of the claims received improper payments, mostly due to insufficient documentation, according to the latest Medicare Quarterly Compliance Newsletter.

CMS Transmittal 3217 , effective April 1, will allow inpatient-only procedures to be included on inpatient claims, similar to other outpatient services included in the three-day window.

Three university hospitals saw a doubling of Recovery Auditor audit activity from 2010–2011 to 2012–2013, and a nearly three-fold increase in overpayment determinations, according to a new study in the Journal of Hospital Medicine.

CMS identified no major problems and a minimal error rate due to invalid coding during its recently completed its first round of end-to-end testing.

Add another nail in the “delay ICD-10 because the industry isn’t ready” coffin. CMS d eclared its end-to-end testing week from January 26 through February 3 a success . A total of 661 volunteers...

CMS' January I/OCE update brought many changes, including new codes, status indicators, and modifiers. Dave Fee, MBA, reviewsthe latest changes and when they will be implemented by CMS.

CMS is adequately preparing to implement ICD-10 October 1, according to a new Government Accountability Office (GAO) report detailing CMS’ transition efforts.

In the 2015 OPPS final rule, CMS introduced a new modifier for services provided in an off-campus, provider-based clinic. Jugna Shah, MPH, and Valerie Rinkle, MPA, review when the modifier will become required and how it should be reported.

In December 2014, CMS posted a document on its Advisory Panel on Hospital Outpatient Payment (HOP Panel) website outlining the hospital outpatient therapeutic services that were recently evaluated for a change in supervision levels. The three-page document contains a chart that includes the HCPCS code, the level of supervision required for coverage, and the effective dates of the changes for various services.

CMS made incorrect payments to hospitals for established patient clinic visits estimated at approximately $4.6 million in 2012, according to a recent Office of Inspector General (OIG) audit.

CMS accepted 76% of all national ICD-10 test claims submitted during its November 2014 ICD-10 acknowledgement testing week. More than 500 providers, suppliers, billing companies, and clearinghouses participated in the tests, which identified no issues with Medicare's system.

CMS proposed that a new HCPCS modifier be appended to every code for a service furnished in a hospital's off-campus provider-based department on both the CMS-1500 claim form for physicians' services and the UB-04 form (CMS Form 1450) for hospital outpatient services in the 2015 OPPS proposed rule. Despite many detailed comments opposing this change, no consensus emerged; therefore, CMS is moving forward with implementing a slightly modified policy.

With the ICD-10 implementation date set for October 1, 2015, CMS has continued its efforts to provide education and information to help organizations prepare for the change. Recently, CMS published a recording of its Transitioning to ICD-10 Provider Call and a new Coding for ICD-10-CM video to YouTube.

Recovery Auditors have identified improper payments for claims involving end-stage renal disease (ESRD) services when more than one monthly service was billed per month and per-day codes exceeded the limit, according to the latest Medicare Quarterly Provider Compliance Newsletter .

Blue Cross and Blue Shield of Michigan, Humana, and other payers formed a consortium to help small physician practices prepare for ICD-10-CM.

AHIMA is calling for coders, billers, and providers to contact Congress to ask for no additional delays to ICD-10 after physician groups have recently started to advocate for members to petition Congress to introduce a new, two-year implementation delay to push the compliance date to October 1, 2017.

CMS finalized a new data collection requirement for services performed in off-campus, provider-based clinics in the 2015 OPPS final rule , which was released October 31.

Beginning January 1, 2015, physicians will no longer need to provide certification for an inpatient admission unless the admission is expected to last for 20 days or longer or the case is an outlier.

Coders aren’t the only ones who run into problems due to a lack of complete physician documentation. Lack of sufficient documentation also causes problems for audit review of submitted claims, which in turn leads to delays in payment, according to the October 2014 Medicare Quarterly Provider Compliance Newsletter .

The four Cooperating Parties released the 2015 ICD-10-CM guidelines and, in the process, deleted a guideline that affects inpatient coding. Both the Centers for Disease Control and Prevention and CMS posted the new guidelines on their websites.

The October update to the OPPS and Integrated Outpatient Code Editor (I/OCE) includes a payment correction, in addition to new HCPCS codes and other changes. Dave Fee, MBA, reviews CMS' changes and details the retroactive payment correction.

CMS recently updated the Medicare Claims Processing Manual , with changes announced in Transmittal 3020 , to include ICD-10-specific language ahead of next year's implementation.

CMS will delay implementation of a chart-abstracted sepsis measure included in the IPPS final rule for fiscal year 2015, the AHA informed members .

CMS is introducing four new HCPCS modifiers to specifically define subsets of modifier -59 (distinct procedural service), the most frequently used modifier.

CMS proposed a major change to physician certification requirements in the 2015 OPPS proposed rule. Kimberly A.H. Baker, JD and James S. Kennedy, MD, CCS, CDIP, break down how the change could affect inpatient admissions.

CMS released its second in a series of Road to 10 webcasts aimed at helping small physician practices prepare for ICD-10 implementation.

October 1, 2015, will be the new ICD-10 implementation date, according to the final rule, Administrative Simplification: Change to the Compliance Date for the International Classification of Diseases, 10th Revision (ICD–10–CM and ICD-10-PCS) Medical Data Code Set, published in the August 4 Federal Register .

The July quarterly I/OCE update from CMS brought few new APCs or edit updates, but did deliver new modifier -L1. Hospitals will use the new modifier to submit outpatient laboratory tests paid under the Clinical Laboratory Fee Schedule (CLFS) in certain circumstances to claim separate payment.

The July quarterly I/OCE update from CMS brought few new APCs or edit updates, but did deliver a new modifier. Debbie Mackaman, RHIA, CHCO, Jugna Shah, MPH , and Denise Williams, RN, CPC-H , explain how to use the modifier, as well as the impact of APC changes.

As part of the 2015 OPPS proposed rule , released July 3, CMS is considering eliminating the requirement for a signed physician certification for most short inpatient stays. CMS would still require a signed physician certification for stays that last 20 days or longer, as well as outlier cases.