MedicareMentor Blog

MedicareFind tip: Ask and answer questions in the MedicareFind Forum

Michael Iarrobino — Fri, 05 Feb 2010 14:51:04 +0000

MedicareMentor Blog readers know this is the place to come for in-depth analysis of Medicare rules and regulations, spearheaded by our Medicare boot camp instructors. We’ve had some great back and forth with blog readers (thanks for this!), and do our best to keep the discussion grounded in authoritative guidance — manuals, rulemaking, etc. If you’re [...]

Interest rate FAQs

Michael Iarrobino — Thu, 04 Feb 2010 15:56:58 +0000

Our friends over at the Revenue Cycle Institute have put together a series of FAQs on the interest rates applicable to overpayments and underpayments. CMS regularly updates these rates via transmittal — if you’ve seen these updates and wanted to know more (the transmittals tend to be very bare…), check it out.

CMS revises “incident to” rules relating to hospital diagnostic services

Judith Kares — Mon, 01 Feb 2010 18:59:36 +0000

During the past several years, CMS has been revising and refining the “incident to” rules that apply to hospital therapeutic services. These rules provide the threshold coverage criteria that must be met in order for hospital therapeutic services to be covered under the Medicare program. In the CY 2010 OPPS final rule, CMS also revised [...]

Medicaid Integrity Contractors: We want to hear from you

Michael Iarrobino — Thu, 28 Jan 2010 21:18:38 +0000

Many of you are probably familiar with the Medicaid Integrity Contractors (MIC), specifically the audit MICs, who are now carrying out their auditing work under the Medicaid Integrity Program. If your organization has undergone a MIC audit, I’d love to hear about your experience. Please e-mail me if you’d be willing to share. Thank you!

New CMS FAQ addresses observation/condition code 44

Michael Iarrobino — Thu, 28 Jan 2010 20:20:46 +0000

CMS has posted a new FAQ related to our ongoing discussion of how to count hours of observation after going through the condition code 44 process: How should the hospital report observation services when the patient’s status is changed from inpatient to outpatient using Condition Code 44? May the hospital report observation services from the beginning [...]

MedicareFind tip: New feature lets you access specific document sections

Michael Iarrobino — Tue, 26 Jan 2010 16:13:39 +0000

One common question that arises when dealing with long guidance documents, especially things like CMS manuals or Federal Register rulemaking, is, How can I find the particular section that I’m interested in? Well, we’ve been working hard to answer that question — and now we’re ready to share our solution with you. MedicareFind users can now take [...]

Changes are on the horizon for critical access hospitals

Debbie Mackaman — Mon, 25 Jan 2010 18:28:34 +0000

In the January 12, 2010 issue of Medicare Weekly Update, we mentioned that CMS had issued a memo summarizing changes in the 2010 Inpatient Prospective Payment System final rule for critical access hospitals (CAH). The IPPS final rule was effective October 1, 2009, and it included two changes that will affect CAHs. This is another [...]

CMS updates instructions to contractors for requesting CMS’ permission to pay claims without first obtaining CWF approval

Judith Kares — Tue, 19 Jan 2010 14:12:26 +0000

The Common Working File (CWF), which tracks beneficiary eligibility information, generally must approve each claim before it is paid. There is a process, however, in the presence of special circumstances, for contractors (e.g., FIs, MACs, Carriers, DMERCs) to request permission from CMS to pay claims without first obtaining CWF approval. CMS recently issued Medicare Claims [...]

Update: Observation hours and condition code 44

Michael Iarrobino — Mon, 18 Jan 2010 17:01:43 +0000

Reader/commenter Sandra McCune (thank you Sandra!) has forwarded to us some new information regarding the counting of observation hours when using condition code 44. As my colleagues Kimberly Hoy and Debbie Mackaman have noted previously on this blog, when an inpatient is converted to outpatient using the condition code 44 process, hospitals should count observation time [...]

MUE Denials Allow Appeals

Kimberly Hoy — Mon, 11 Jan 2010 21:21:00 +0000

This week CMS reissued a transmittal from December with detailed instructions on contractor handling of Medically Unlikely Edits (MUEs). The new instructions should make appealing MUEs possible for hospitals, but there is still some confusing guidance on billing multiple units. Effective April 1, 2010, CMS has instructed MACs and FIs to deny claim lines with units [...]