Revenue Cycle Institute

Note from the instructor: CMS clarifies payment amount to be applied to payment caps and manual review thresholds for outpatient therapy services provided by critical access hosptials

jzagami — Sun, 19 May 2013 20:50:55 +0000

This week’s note from the instructor is written by Judith Kares, JD, regulatory specialist for HCPro, Inc. General Guidelines In the April 2, 2013 issue of the Medicare Insider, Debbie Mackaman discussed the provisions of the American Taxpayer Relief Act (the “ATRA”) related to outpatient therapy services furnished in various outpatient settings (including outpatient hospital [...]

HDI posts one new issue

jzagami — Sun, 19 May 2013 19:43:40 +0000

HDI posted one issue for DME/non-physician to its CMS approved list for providers in Region D. (See link for individual state applicability.) According to the HDI website, the issue is: For DME/non-physician: Excessive Units of Spring Powered Device. More than one spring powered device (A4258) per 6 months is not reasonable and necessary.

Connolly posts one new issue

jzagami — Sun, 19 May 2013 19:42:34 +0000

Connelly posted one issue for Skilled Nursing Facilities (SNF) to its CMS approved list for providers in Region C. (See link for individual state applicability.) According to the Connolly website, the issue is: For SNF: Units in Excess of PPS Assessment Maximum – C002842013. Medicare assigns standard scheduled payment periods for SNF assessments. Overpayment occurs [...]

Connolly posts nine new issues in one category

jzagami — Mon, 13 May 2013 21:30:08 +0000

Connolly posted nine new issues in one category to its CMS approved list for providers in Region C. (See link for individual state applicability. According to the Connolly website, the new issues are: For inpatient claims: CMS Pre-Pay Demonstration: MS-DRG 639- Diabetes without CC/MCC – C002812013. The Recovery Audit Prepayment Review Demonstration will allow Medicare [...]

Note from the Instructor: Guidance on Implementing Sequestration under the Medicare Fee-for-Service Program

jzagami — Tue, 07 May 2013 20:20:14 +0000

This week’s note from the instructor is written by Judith Kares, JD, CPC, regulatory specialist for HCPro, Inc. A number of hospitals and other providers have been asking CMS for additional guidance on the practical aspects of implementing “sequestration” under the Medicare program. Sequestration, as enacted under the Budget Control Act of 2011 (the “Budget [...]

Connolly posts twelve new issues across six categories

cpickering — Mon, 06 May 2013 20:58:02 +0000

Connolly posted twelve new issues across six categories to its CMS approved list for providers in Region C. (See link for individual state applicability.) According to the Connolly website, the new issues are: For Comprehensive Outpatient Rehab Facility (CORF) claims: Postpayment Review – Manual Medical Review of Therapy Claims Above the $3,700 Threshold (CORF) – [...]

Performany Recovery posts four new issues across three categories

cpickering — Mon, 06 May 2013 20:41:49 +0000

Performant Recovery posted four new issues across three categories to its CMS approved list for providers in Region A. (See link for individual state applicability.) According to the Performant website, the new issues are: For outpatient hospital claims: Zoledronic Acid (Zometa®) Excessive Daily Units – J13. Potential incorrect billing occurred when Zoledronic Acid (Zometa®), HCPCS [...]

Connolly posts eight new issues across two categories

cpickering — Mon, 29 Apr 2013 21:57:24 +0000

Connolly Healthcare added eight new issues across two categories—three for inpatient hospital claims and five for SNF claims— to its CMS-approved list for providers in Region C states. (See link for individual state applicability.) According to the Connolly website, the new issues are as follows: For inpatient hospital claims: Medical Necessity: Diseases And Disorders Of [...]

Performant posts one new issue in Physician/Nonphysician Practitioner category

cpickering — Mon, 29 Apr 2013 21:41:01 +0000

Performant Recovery added one new issue in the Physician/Nonphysician Practitioner category to its CMS-approved list for providers in Region A. (See link for individual state applicability). According to the Performant website, the news issue is: Procedures in the Post Op Period of Other Procedures – All of Region A. Additional major and minor surgical procedures [...]

Performant posts fourteen new issues across nine categories

cpickering — Mon, 22 Apr 2013 21:43:13 +0000

Performant Recovery added fourteen new issues across nine categories to its CMS-approved list for providers in Region A. (See link for individual state applicability). According to the Performant website, the news issue are: For skilled nursing facility (Part B only) Postpayment Review – Manual Medical Review of Outpatient Therapy Claims Above the $3,700 Threshold. The [...]

CMS releases additional guidance on Part A to B rebilling

cpickering — Wed, 17 Apr 2013 15:21:59 +0000

This week’s note from the instructor is written by Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc. Over the past few weeks, CMS has released several documents regarding the rule change that allows for full Part B payment for certain inpatient stays that were previously denied by a Medicare contractor as being not reasonable [...]

Connolly posts 56 new issues across two categories

cpickering — Tue, 16 Apr 2013 16:49:22 +0000

Connolly Healthcare added 56 new issues across two categories—one for outpatient hospital claims and 55 for inpatient hospital claims— to its CMS-approved list for providers in Region C states. (See link for individual state applicability.) According to the Connolly website, the new issues are as follows: For outpatient hospital claims Incorrect Billing of Per Day [...]

CGI posts nine issues in one category

cpickering — Tue, 16 Apr 2013 16:45:31 +0000

CGI added nine new issues across one category – inpatient claims – to its CMS-approved list for providers in all Region B states. According to the CGI website, the new issues are: Seizures MS-DRG 100 and 101 (Medical Necessity). The purpose of this complex review is to identify claims that have been reviewed validating medical [...]

Performant posts four new issues across two categories

cpickering — Tue, 16 Apr 2013 16:41:14 +0000

Performant Recovery added four new issues across two categories—two for inpatient hospital claims and two for physician/non-physician practitioner claims—to its CMS-approved list for providers in Region A. (See link for individual state applicability). According to the Performant website, the news issue are: For inpatient hospital claims Medical Necessity Review (MNR) for MS-DRG 193 Simple Pneumonia [...]

CMS continues to provide updates on the Medicare and Medicaid EHR Incentive Programs

cpickering — Wed, 10 Apr 2013 18:56:47 +0000

Editor’s note: Judith Kares, JD, CPC, regulatory specialist for HCPro, Inc., is the author of this week’s note from the instructor. To keep eligible professionals, hospitals and critical access hospitals (CAHs) informed on the Medicare and Medicaid Electronic Health Record Incentive Programs (the “EHR Incentive Programs”), CMS has recently added two new Frequently Asked Questions [...]

Manual medical review by Recovery Auditors of outpatient therapy claims begins April 1

cpickering — Mon, 01 Apr 2013 18:48:58 +0000

This week’s note from the instructor is written by Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc. During the last quarter of 2012, hospital outpatient departments temporarily fell under the therapy caps and manual medical review provisions as required under the Middle Class Tax Relief and Job Creation Act. On January 2, 2013, the [...]

HCPro announces fifth annual Medicare Compliance Forum

James Carroll — Wed, 27 Mar 2013 15:33:52 +0000

Medicare Compliance Forum was created to help you discover practical approaches to addressing important Medicare compliance, as well as Medicare revenue cycle concerns. This program will help you recognize key risk areas from government auditors including Recovery Auditors, MACs, and the OIG, and learn how to prepare the best defense to protect your organization. You’ll [...]

Connolly posts four new issues across two categories

James Carroll — Mon, 25 Mar 2013 18:18:51 +0000

Connolly Healthcare added four new issues across two categories—two for outpatient hospital and two for carrier claims— to its CMS-approved list for providers in Region C states. (See link for individual state applicability.) According to the Connolly website, the new issues are as follows: For hospital outpatient claims Non-covered use of arpetitant (J8501) – C001142013 [...]

CGI posts four issues for medical necessity claims

James Carroll — Mon, 25 Mar 2013 18:12:27 +0000

CGI added four new issues for medical necessity claims to its CMS-approved list for providers in all Region B states. According to the CGI website, the news issue are: Mental diseases and disorders MDC 19 MS-DRGs 880-887. The purpose of this complex review is to identify claims that have been reviewed validating medical necessity in [...]

Performant Recovery posts three new issues across three categories

James Carroll — Mon, 25 Mar 2013 18:05:10 +0000

Performant Recovery added three new issues across three categories—One for outpatient hospital claims, one for physician/nonphysician practitioner claims, and one for DME claims—to its CMS-approved list for providers in Region A. (See link for individual state applicability). According to the Performant website, the new issues are: For DME claims Ankle-Foot Orthosis – JA. Potential incorrect [...]