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Issue #203 - August 15, 2012

AAPC EdgeBlast a

CMS Issues Inpatient Final Rule

The Centers for Medicare & Medicaid Services (CMS) issued, Aug. 1, a final rule for 2013 payment policies for inpatient stays at general acute care and long-term care hospitals (LTCH). The new rule includes elements of the Affordable Care Act (ACA) hospital value-based purchasing and hospital re-admissions reduction programs. The rule also includes new efforts to tie Medicare payments to quality health care across the delivery system, with new quality reporting measures for hospitals in 2015 and 2016, new measures for LTCHs in 2016, and new quality reporting programs for psychiatric and cancer hospitals.

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CMS Rule Seeks to Streamline EFT and Remittance

The Centers for Medicare & Medicaid Services (CMS) released, Aug. 7, an interim final rule with comment period that specifies additional guidelines for health care electronic funds transfers (EFT) and electronic remittance advice (ERA) transactions. The goal is to allow health information "to be exchanged more efficiently, and to achieve greater uniformity in the transmission of health information ... by applying necessary business rules and guidelines for the electronic exchange of information," according to CMS.

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2013 Hospice Care Payment Rates

Payment rates for hospice care, the hospice aggregate cap amount, and the hospice wage index are updated annually. The 2013 payment rates equal the 2012 payment rates plus 1.6 percentage points. The new rates are effective for care and services from Oct. 1, 2012 through Sept. 30, 2013.

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Health Collector Pays $2.5 Million, Banned from State

Accretive Health, a national health debt collector, has agreed to pay Minnesota $2.5 million to settle accusations it violated a federal law requiring hospitals to provide emergency care regardless of the patients' ability to pay. In an unusual move, the company was also barred from contracting with Minnesota hospitals for two years and must have the attorney general's permission to do business in the state for four years after that. Accretive has not admitted wrongdoing, according to Minneapolis StarTribune.

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Aetna, Partner Offering ACO Price Guarantee

Healthcare Payer News reports a new accountable care health plan from Aetna and Aurora Health Care will offer a price guarantee to employers, many of whom may see an average reduction of 10 percent based on their past claims expenses. The Aurora Accountable Care Network's price guarantee may be the first offering of its kind, and is designed primarily to meet the insurance needs of small- and mid-sized employers in Wisconsin.

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Paper Claims Returned for Item 33b

National Government Services, a durable medical equipment Medicare administrative contractor (DME MAC), is returning paper claims when providers fill in item 33b. The DME MAC for Jurisdiction B reports an increase in the number of paper claims returned to suppliers because item 33b of the CMS-1500 paper claim form contained either the Provider Transaction Access Number (PTAN) or National Provider Identifier (NPI).

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Patients Came Back in Second Quarter

Physicians were busier than they've been in a long time in the second quarter of 2012, American Medical News reports, with visits increasing almost 5 percent on average. This reverses a downward trend starting in 2008; providers saw a nearly 9 percent decline the same quarter of 2011. This points to an improving economy for both patients and their caregivers, some experts say.

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Coding Tips

CMS Posts Final Decision for Autologous PRP Coverage
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MACs Will Decide Liver Transplant Coverage for CA
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Medical News

S.C. Hospital Notifies 11 of Creutzfeldt-Jakob Disease Risk
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New Online Map Eases Access to CMS Orgs
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Mass. Bill May Control Health Care Costs
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Featured Items
CMS Inpatient Final Rule
EFT/ERA Operating Rule
Hospice Care Payment
Health Collector Pays
Aetna's ACO Guarantee
Paper Claims for Item 33b
Patients Came Back
Coding Tips
Medical News
Coding Job Links



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