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Issue #198 - June 6, 2012

AAPC EdgeBlast

CMS Offers Tips to Avoid 5010 Rejections

The Centers for Medicare & Medicaid Services (CMS) suggests in a May 24 news update ways to help avoid claims rejections when Version 5010 goes into effect. Providers and payers must be using Version 5010 to electronically file claims by July 1, a six-month extension past the original date of Jan. 1.

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Final Rules Reduce Fed Control for Hospitals

In accordance with President Obama's regulatory reform initiative to reduce unnecessary burdens on business and cut unnecessary spending, the Centers for Medicare & Medicaid Services (CMS) finalized two rules May 9. The first rule, Reform of Hospital and Critical Access Hospital Conditions of Participation, revises the requirements that hospitals and critical access hospitals (CAHs) must meet to participate in the Medicare and Medicaid programs. CMS estimates that this rule will save hospitals and CAHs approximately $900 million in the first year. The second rule, Medicare Regulatory Reform, identifies and reduces or eliminates Medicare and Medicaid regulations that CMS has deemed unnecessary, obsolete, or excessively burdensome. CMS estimates this rule will cut costs by as much as $200 million in the first year and $100 million each year thereafter.

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CMS Fails to Collect Millions in Overpayments, OIG Says

According to the U.S. Department of Health & Human Services (HHS) Office of Inspector General (OIG), the Centers for Medicare & Medicaid Services (CMS) failed to collect at least $332.1 million in Medicare overpayments identified during a 30-month period including years 2007, 2008, and the first six months of 2009.

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July Outpatient Editor Update Includes NCCI Changes

July 2012 updates to the Integrated Outpatient Code Editor (I/OCE), the Centers for Medicare & Medicaid Services’ (CMS) system for filing and adjudicating claims paid under the Outpatient Prospective Payment System (OPPS), include a change to bring it in line with correct coding guidelines. The OCE is used for outpatient services in hospitals and ambulatory surgical centers (ASCs).

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Look for New Codes, New Status Indicators in July ASC PS Update

The July update of the Ambulatory Surgical Center Payment System (ASC PS) implements several changes to Medicare billing instructions of which ASC coding and billing staff should be aware. The update includes new Category III codes, new instructions for device pass-through category C1840, and billing changes for medication. Billing staff, in particular, should take note of payment indicator changes for certain drug supply codes as claims adjustments may be necessary.

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July DMEPOS Update Includes Retroactive Changes

The Centers for Medicare & Medicaid Services’ (CMS’) July Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) update includes changes retroactive to Jan. 1, 2012.

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Coding Tips

O2 for Cluster Headaches Paid After Oct. 1
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Balance Bill Patients if You Encounter Error Codes H20203, H45255
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Extracorporeal Photopheresis for BOS Now Covered
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Both Depth and Area Matter when Reporting Debridement
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Check Ultrasound Diagnostics for Transesophageal Doppler Coverage
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Look to MLN Newsletter for Top Billing Errors
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Medical News

Diabetics See a Drop in Heart Disease and Stroke Deaths
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Featured Items
Avoid 5010 Rejections
Reduced Fed Control
Millions in Overpayments
July I/OCE Update
July ASC PS Update
July DMEPOS Update
Coding Tips
Medical News
Coding Job Links


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