MedicareMentor Blog

CMS issuing National Coverage Determinations (NCDs) with ICD-10 translations

Kimberly Hoy — Mon, 21 May 2012 18:46:02 +0000

This week CMS issued NCD and Claims Manual transmittals on the coverage of extracorporeal photopheresis for the treatment of bronchiolitis obliterans syndrome (BOS) in certain circumstances under clinical research studies. The NCD and claims instructions are fairly self-explanatory, but I wanted to take the opportunity to talk about how CMS seems to be approaching the [...]

New CoP addresses patient self-administration of medications

Kimberly Hoy — Tue, 15 May 2012 15:19:05 +0000

CMS put on display two rules on May 9 designed to reduce the regulatory burden on providers and save hospitals nearly a billion dollars a year in administrative costs. But at least one provision in the new rules is aimed at saving costs for patients as well. A change to the Conditions of Participation (CoP) for [...]

CMS issues further guidance on outpatient therapy caps and the related exceptions process

Judith Kares — Mon, 07 May 2012 19:21:11 +0000

In a recent transmittal, CMS issued guidance on Congress’ extension of limitations on certain therapy services, as well as the related exceptions process, through December 31, 2012. Under the Balanced Budget Act of 1997, Congress initially imposed financial limitations on specific outpatient therapy services (physical, occupational and speech-language pathology) provided in all settings except hospital [...]

Changes to CMS’ website are not all good

Peggy Blue — Wed, 02 May 2012 15:02:51 +0000

CMS has done a lot of restructuring to their website recently. I can’t speak about all of the revisions they have made, but I can address the functionality of the Transmittals page. It is a change, to be sure, but I certainly would not call it an improvement. I read every transmittal that CMS releases, [...]

CMS releases the IPPS Proposed Rule

Debbie Mackaman — Tue, 01 May 2012 14:59:06 +0000

It’s that time of the year again when some things are for certain – trees and flowers are in bloom creating havoc with allergies, the weather can’t make up its mind if its spring or winter and CMS announces its plans for the coming fiscal year regarding IPPS hospital payments. Last week CMS released the inpatient [...]

Note from the Instructor: ICD-10 Delay

Kimberly Hoy — Tue, 24 Apr 2012 13:44:40 +0000

This week CMS published a proposed date for the delay of ICD-10 implementation. They are proposing to delay from October 1, 2013 to October 1, 2014. This is only a proposed rule and arguably the delay could be even longer if sufficient comments were submitted to convince CMS of the need for a longer delay. [...]

CMS provides additional guidance on proper billing when the Medicare Secondary Payer Rules apply

Judith Kares — Mon, 16 Apr 2012 19:07:24 +0000

In a recent Special Edition MLN Matters Article (SE1217), CMS reminded providers of their responsibilities under the Medicare Secondary Payer (MSP) Rules. Under the MSP Rules, Medicare is secondary to certain other payers in the specific circumstance.

CMS clarifies regulations for outpatient rehabilitation and respiratory services

Debbie Mackaman — Mon, 09 Apr 2012 17:32:39 +0000

On March 23, CMS issued Transmittal 81 removing controversial language from Appendix A of the State Operations Manual for Hospitals. The Interpretive Guidelines and Survey Procedures language that was removed had stated that the ordering practitioner must have medical staff privileging to write the orders for rehabilitation and respiratory services.

March 2012 update to the Medicare Physician Fee Schedule

Peggy Blue — Wed, 04 Apr 2012 17:34:58 +0000

As expected, Congress finally passed legislation saving physicians from the drastic reduction in the Medicare Physician Fee Schedule conversion factor that was supposed to take place on January 1, 2012 and then postponed until March 1, 2012. Now that the Middle Class Tax Relief and Job Creation Act (MCTRJCA) of 2012 has been signed into law we can expect the conversion factor to remain at $34.0376 for the remainder of 2012.

NCCI edits more user-friendly despite some modifier confusion

Kimberly Hoy — Tue, 03 Apr 2012 14:01:46 +0000

CMS has recently made a number of improvements to the usefulness of the NCCI edits including a new format to the files effective this month. Additionally, there have been some changes to the modifiers used to override NCCI edits, which warrants discussion of the 76, 77, 78, and 79 modifiers.