For the full article, click here.
Thursday, February 27, 2014
ICD-10 deadline won't be delayed, Tavenner tells HIMSS
Providers, payers and claims clearinghouses can look for no relief from the looming, Oct. 1 compliance deadline for the nationwide conversion to the ICD-10 family of diagnostic and procedural codes, the head of the CMS said Thursday. But some case-by-case exemptions will be made for providers having a tough time meeting their Stage 2 meaningful-use targets, she said.
How to Get In Contact with Your RCCO
The Regional Care Collaborative Organization (RCCO) connects Medicaid clients to Medicaid providers and also helps Medicaid clients find community and social services in their area. The RCCO helps providers to communicate with Medicaid clients and with each other, so Medicaid clients receive coordinated care. A RCCO will also help Medicaid clients get the right care when they are returning home from the hospital or a nursing facility, by providing the support needed for a quick recovery. A RCCO helps with other care transitions too, like moving from children's health services to adult health services, or moving from a hospital to nursing care.
Need more information on your RCCO? Click on the links below!
RCCO 1: Rocky Mountain Health Plan Accountable Care Collaborative - Member Handbook
RCCO 2: Colorado Access Regional Accountable Care Collaborative - Member Handbook
RCCO 3: Colorado Access Regional Accountable Care Collaborative - Member Handbook
RCCO 4: Integrated Community Health Partners - Member Handbook
RCCO 5: Colorado Access Regional Accountable Care Collaborative - Member Handbook
RCCO 6: Colorado Community Health Alliance - Member Handbook
RCCO 7: Community Care - Member Handbook
To figure out which RCCO you are located in, please see our map below.
Information and map provided by Colorado.gov
Telehealth Webinar March 12, 2014
Improving Access to Quality Medical Care
The practice and delivery of healthcare is changing, with an emphasis on improving quality, safety, efficiency, & access to care. Telemedicine can help you achieve these goals! The University of Arizona Center for Rural Health & the Southwest Telehealth Resource Center invite you to a free webinar on the implementation and practice of telemedicine.
For further details click here.
The practice and delivery of healthcare is changing, with an emphasis on improving quality, safety, efficiency, & access to care. Telemedicine can help you achieve these goals! The University of Arizona Center for Rural Health & the Southwest Telehealth Resource Center invite you to a free webinar on the implementation and practice of telemedicine.
For further details click here.
Additional Enhancements to the Novitas Solutions Website
In continued response to customer feedback, Novitas Solutions will be making additional enhancements to the website effective March 3. Enhancements include:
· New pop-up selector box - Immediately after you select your jurisdiction from the Novitas Solutions Home Page, you will be required to select your Line of Business (LOB) - Part A or Part B. This will result in your seeing information specific to the jurisdiction and LOB you selected. You can switch between Part A or Part B at any time by using the link located above the left navigation menu.
· Left navigation menu redesign - Rollout menus from each Center will now provide easy, one-click access to the most requested features within that Center. Simply roll-over or select the Center to access the available Rollout menus. Menus will be customized based on your LOB selection (Part A or Part B).
· New pop-up selector box - Immediately after you select your jurisdiction from the Novitas Solutions Home Page, you will be required to select your Line of Business (LOB) - Part A or Part B. This will result in your seeing information specific to the jurisdiction and LOB you selected. You can switch between Part A or Part B at any time by using the link located above the left navigation menu.
· Left navigation menu redesign - Rollout menus from each Center will now provide easy, one-click access to the most requested features within that Center. Simply roll-over or select the Center to access the available Rollout menus. Menus will be customized based on your LOB selection (Part A or Part B).
The Secret’s Out: The Key To Unlock Your Grantor’s Interest:
Many successful grant writers agree that the key to unlocking the door of your grantor’s interest is simply through effectively answering the question: What is the need that my organization will address? It’s the single most important narrative that clearly and convincingly describes and demonstrates why the project should be funded (e.g., benefits, end products, etc.). The central goal, in any grant whether CREATE or other, is to convince the reviewers of the legitimacy of your problem. They want to know your solution is viable, and that you can execute/accomplish your solution. What a grant application essentially does is sell your need and solution to the funder. Here are a few tips in CREATE-ing your needs narrative?
- Explain why your organization needs this grant? If you receive this grant, how would this grant benefit your organization? Describe and document your need. Support the existence of the project/request with data from surveys, patient call type reports, etc.
- What is the overall community need? How would XXX community benefit if you received grant funding? (e.g.; small rural volunteer led agency with only 6 trained paramedics whom service a large tourist community with increased service need during high ski season.
- List past success with previous grant funds related to the current project.
For additional tips and more information about CREATE, contact Lakesha Jones, Grants Manager at (720) 248-2742 or by email at lj@coruralhealth.org .
12 Month Continuous Eligibility for Children in Medicaid or CHP+ Program
Beginning March 1st,
the 12 month continuous eligibility policy for children under the age of 19 in
the Medicaid or Child Health Plan Plus (CHP+) programs will be
implemented. Continuous eligibility ensures children remain enrolled in
either Medicaid or CHP+ for 12 months, regardless of whether their household
experiences a change in income or size. For more information on
continuous eligibility, please see the Department of Health Care Policy and
Financing’s frequently asked questions here or
go to Colorado.gov/HCPF/ACAResources.
Wednesday, February 26, 2014
CERT A/B MAC Outreach & Education Task Force
The CERT A/B MAC Outreach & Education Task Force, a partnership of all A/B Medicare Administrative Contractors, created this Task Force Scenario: Documenting Therapy and Rehabilitation Services guide to educate providers on common documentation errors for outpatient rehabilitation therapy services. These widespread errors contribute to Medicare’s national payment error rate, as measured by the Comprehensive Error Rate Testing (CERT) program.
For the full guide, please click here.
For the full guide, please click here.
Tuesday, February 25, 2014
Medicare Part A
Medicare News
Availability of the Proposed Federal Fiscal Year (FY) 2015 Wage Index Public Use Files (PUFs) and Deadline for Requesting Corrections to the Wage Index Data
On or about Thursday, February 20, 2014, the Centers for Medicare & Medicaid Services (CMS) released the proposed FY 2015 wage index PUFs. This notice addresses the criteria and process for hospitals to request corrections to their wage index data. All requests from hospitals for corrections to their FY 2015 wage index data must be submitted to and received by their Medicare Administrative Contractors (MACs) on or before March 3, 2014. Visit the Wage Index homepage for full details.
New Medicare Insights Weekly Podcasts Ready for Download
In this week's Medicare Insights Weekly podcast we discuss the Local Coverage Determination retirement process. We also include news on website navigation frequently asked questions, enhancements to our website and introduce the Comprehensive Error Rate Testing (CERT) A/B MAC Outreach & Education Task Force Scenario: Documenting Therapy and Rehabilitation Services guide. Click on our podcast links and start listening today!
Reminder about Reason Code 30940
Reason code 30940 is received when attempting to adjust a claim with a medically denied line. If you are trying to add diagnosis codes, change CPT codes or move denied charges from non-covered to covered, you must submit a redetermination.
If you are attempting to electronically adjust/add charges to a claim with a denied line (without altering the denied line), there is an identified 5010 issue. The issue is causing reason code 30940 to edit incorrectly. Though 5010 electronic claims are receiving the error you can submit the adjustment via DDE to avoid the claim editing for 30940. Remember, the denied line should not be altered in any way.
Availability of the Proposed Federal Fiscal Year (FY) 2015 Wage Index Public Use Files (PUFs) and Deadline for Requesting Corrections to the Wage Index Data
On or about Thursday, February 20, 2014, the Centers for Medicare & Medicaid Services (CMS) released the proposed FY 2015 wage index PUFs. This notice addresses the criteria and process for hospitals to request corrections to their wage index data. All requests from hospitals for corrections to their FY 2015 wage index data must be submitted to and received by their Medicare Administrative Contractors (MACs) on or before March 3, 2014. Visit the Wage Index homepage for full details.
New Medicare Insights Weekly Podcasts Ready for Download
In this week's Medicare Insights Weekly podcast we discuss the Local Coverage Determination retirement process. We also include news on website navigation frequently asked questions, enhancements to our website and introduce the Comprehensive Error Rate Testing (CERT) A/B MAC Outreach & Education Task Force Scenario: Documenting Therapy and Rehabilitation Services guide. Click on our podcast links and start listening today!
Reminder about Reason Code 30940
Reason code 30940 is received when attempting to adjust a claim with a medically denied line. If you are trying to add diagnosis codes, change CPT codes or move denied charges from non-covered to covered, you must submit a redetermination.
If you are attempting to electronically adjust/add charges to a claim with a denied line (without altering the denied line), there is an identified 5010 issue. The issue is causing reason code 30940 to edit incorrectly. Though 5010 electronic claims are receiving the error you can submit the adjustment via DDE to avoid the claim editing for 30940. Remember, the denied line should not be altered in any way.
Medicare Part B
Medicare News
New Medicare Insights Weekly Podcasts Ready for Download
In this week's Medicare Insights Weekly podcast we discuss the Local Coverage Determination retirement process. We also include news on website navigation frequently asked questions, enhancements to our website and introduce the Comprehensive Error Rate Testing (CERT) A/B MAC Outreach & Education Task Force Scenario: Documenting Therapy and Rehabilitation Services guide. Click on our podcast links and start listening today!
Evaluation and Management Score Sheet - Four Part Series
We are continuing the Evaluation and Management Score Sheet - Four Part Series - beginning again on March 6. Join us for "Part One: Understanding the Key Components of Evaluation and Management Services". Please visit our events center to register!
This four part series was developed to increase your understanding of evaluation and management services. The complete series will be presented every month with one part each week. It is recommended to take the entire series in order to maximize your understanding. However, if you miss any part of the series, it will be presented again the following month in the same order.
The series will consist of the following:
Week One-Part One- Understanding the Key components of Evaluation and Management.
Week Two-Part Two- Introduction to the Score Sheet
Week Three- Part Three- Using the Score Sheet
Week Four- Part Four- Scoring Medical Records Using the Score Sheet.
If you are new to documenting and/or scoring evaluation and management services, this webinar event is for you. You must attend this event.
New Medicare Insights Weekly Podcasts Ready for Download
In this week's Medicare Insights Weekly podcast we discuss the Local Coverage Determination retirement process. We also include news on website navigation frequently asked questions, enhancements to our website and introduce the Comprehensive Error Rate Testing (CERT) A/B MAC Outreach & Education Task Force Scenario: Documenting Therapy and Rehabilitation Services guide. Click on our podcast links and start listening today!
Evaluation and Management Score Sheet - Four Part Series
We are continuing the Evaluation and Management Score Sheet - Four Part Series - beginning again on March 6. Join us for "Part One: Understanding the Key Components of Evaluation and Management Services". Please visit our events center to register!
This four part series was developed to increase your understanding of evaluation and management services. The complete series will be presented every month with one part each week. It is recommended to take the entire series in order to maximize your understanding. However, if you miss any part of the series, it will be presented again the following month in the same order.
The series will consist of the following:
Week One-Part One- Understanding the Key components of Evaluation and Management.
Week Two-Part Two- Introduction to the Score Sheet
Week Three- Part Three- Using the Score Sheet
Week Four- Part Four- Scoring Medical Records Using the Score Sheet.
If you are new to documenting and/or scoring evaluation and management services, this webinar event is for you. You must attend this event.
ICD-10 Road Shows March and April
The CHIMA ICD-10 Task Force has been hard at work planning the 2014 ICD-10 Roadshows.
The ICD-10-Road Shows are set for March & April 2014 in Denver, Pueblo, Greeley and Grand Junction! 1-1/2 days of education focused on ICD-10-CM with hands on coding sessions. Colorado’s own AHIMA Approved ICD-10 Trainers will be leading the education. $250 CHIMA members, $300 non-members and $50 for students. Seminar materials and lunch/breakfast provided for these Friday(full day) and Saturday(morning) sessions.
To view meeting details and to register, click here. Please contact Jacquie Zegan & Michele Benson @ chimai10taskforce@gmail.com if you have questions or would like more information.
The ICD-10-Road Shows are set for March & April 2014 in Denver, Pueblo, Greeley and Grand Junction! 1-1/2 days of education focused on ICD-10-CM with hands on coding sessions. Colorado’s own AHIMA Approved ICD-10 Trainers will be leading the education. $250 CHIMA members, $300 non-members and $50 for students. Seminar materials and lunch/breakfast provided for these Friday(full day) and Saturday(morning) sessions.
To view meeting details and to register, click here. Please contact Jacquie Zegan & Michele Benson @ chimai10taskforce@gmail.com if you have questions or would like more information.
CMS Fact Sheet
CMS Media Relations
February 24, 2014
CMS Seeks Input on Next Phase of Competitive Bidding Implementation
Contact: (202) 690-6145 or press@cms.hhs.gov
Overview
The Centers for Medicare & Medicaid Services (CMS) today announced that it will seek public comment as it moves toward nationwide implementation of the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program. The Competitive Bidding Program, established by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Medicare Modernization Act or MMA), has saved more than $400 million for beneficiaries and taxpayers in its first two years of operation and is projected to save an additional $17.2 billion for beneficiaries and $25.8 billion for the Medicare program over the next 10 years.
Currently, competitive bidding is in effect for a national mail order program for diabetic testing supplies and for additional items in 100 areas across the country. By 2016, Medicare must implement competitive bidding or competitive bidding pricing for included items to non-competitive bidding areas. CMS is soliciting public comment on the methodology it would use to comply with the statute when using competitive bidding pricing information to adjust payment amounts in non-competitive bidding areas. In addition, CMS is requesting comments regarding ideas for potentially simplifying the payment rules and enhancing beneficiary access to items and services under the competitive bidding programs for certain durable medical equipment (DME) and enteral nutrition.
Click Here for more information.
February 24, 2014
CMS Seeks Input on Next Phase of Competitive Bidding Implementation
Contact: (202) 690-6145 or press@cms.hhs.gov
Overview
The Centers for Medicare & Medicaid Services (CMS) today announced that it will seek public comment as it moves toward nationwide implementation of the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program. The Competitive Bidding Program, established by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Medicare Modernization Act or MMA), has saved more than $400 million for beneficiaries and taxpayers in its first two years of operation and is projected to save an additional $17.2 billion for beneficiaries and $25.8 billion for the Medicare program over the next 10 years.
Currently, competitive bidding is in effect for a national mail order program for diabetic testing supplies and for additional items in 100 areas across the country. By 2016, Medicare must implement competitive bidding or competitive bidding pricing for included items to non-competitive bidding areas. CMS is soliciting public comment on the methodology it would use to comply with the statute when using competitive bidding pricing information to adjust payment amounts in non-competitive bidding areas. In addition, CMS is requesting comments regarding ideas for potentially simplifying the payment rules and enhancing beneficiary access to items and services under the competitive bidding programs for certain durable medical equipment (DME) and enteral nutrition.
Click Here for more information.
Thursday, February 20, 2014
Novitas Solutions/Medicare News Part A & B
Enhancements to the Novitas Solutions Website
Novitas Solutions is pleased to announce enhancements to the Novitas Solutions website. After selecting your jurisdiction from the Home Page, the website opens to the new Novitas Start Center with the familiar Navigation Centers on the left hand side. This new Novitas Start Center prominently displays frequently used items and information. The creation and format of this Center was based on feedback received from you, our customer, and your requests to provide quick access to those items and information. The Center contains Self-Service Features, New & Popular Topics, Contact Information and System & Informational Alerts. The Self-Service Features provide a direct link to some of the most utilized features and tools currently available on the Novitas Solutions website. Some of the tools available are the Appeals Status Inquiry Tool and the Enrollment Status Lookup. By selecting the Appeals Status Inquiry Tool, you are able to determine status of a Part A or Part B appeal that has been submitted. The Enrollment Status Lookup provides a status history of all Part A and Part B Internet-based Provider Enrollment, Chain and Ownership System (Internet-based PECOS) or paper–submitted CMS-855/588 (EFT) applications. Some of the other enhancements include updates to some of the main titles on the left side Navigation Centers (e.g., LCD/Medical Policy, News & Bulletins, Contact Us, etc.), including placing the listing in alphabetical order for ease of use and quick location of information. Please visit the Novitas Solutions website, select your jurisdiction and view the most recent updates.
Thank you for your patience as we continue to work toward a quality product and provision of information that is easily accessed and available on the Novitas Solutions website.
Medicare Learning Network Matters Articles from CMS
New
MM8597 – Correction CR - Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131
SE1409 - Medicare Fee-For-Service (FFS) International Classification of Diseases, 10th Edition (ICD-10) Testing Approach
Task Force Scenario: Documenting Therapy and Rehabilitation Services
The CERT A/B MAC Outreach & Education Task Force, a partnership of all A/B Medicare Administrative Contractors, created this guide to educate providers on common documentation errors for outpatient rehabilitation therapy services. These widespread errors contribute to Medicare’s national payment error rate, as measured by the Comprehensive Error Rate Testing (CERT) program.
Novitas Solutions is pleased to announce enhancements to the Novitas Solutions website. After selecting your jurisdiction from the Home Page, the website opens to the new Novitas Start Center with the familiar Navigation Centers on the left hand side. This new Novitas Start Center prominently displays frequently used items and information. The creation and format of this Center was based on feedback received from you, our customer, and your requests to provide quick access to those items and information. The Center contains Self-Service Features, New & Popular Topics, Contact Information and System & Informational Alerts. The Self-Service Features provide a direct link to some of the most utilized features and tools currently available on the Novitas Solutions website. Some of the tools available are the Appeals Status Inquiry Tool and the Enrollment Status Lookup. By selecting the Appeals Status Inquiry Tool, you are able to determine status of a Part A or Part B appeal that has been submitted. The Enrollment Status Lookup provides a status history of all Part A and Part B Internet-based Provider Enrollment, Chain and Ownership System (Internet-based PECOS) or paper–submitted CMS-855/588 (EFT) applications. Some of the other enhancements include updates to some of the main titles on the left side Navigation Centers (e.g., LCD/Medical Policy, News & Bulletins, Contact Us, etc.), including placing the listing in alphabetical order for ease of use and quick location of information. Please visit the Novitas Solutions website, select your jurisdiction and view the most recent updates.
Thank you for your patience as we continue to work toward a quality product and provision of information that is easily accessed and available on the Novitas Solutions website.
Medicare Learning Network Matters Articles from CMS
New
MM8597 – Correction CR - Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131
SE1409 - Medicare Fee-For-Service (FFS) International Classification of Diseases, 10th Edition (ICD-10) Testing Approach
Task Force Scenario: Documenting Therapy and Rehabilitation Services
The CERT A/B MAC Outreach & Education Task Force, a partnership of all A/B Medicare Administrative Contractors, created this guide to educate providers on common documentation errors for outpatient rehabilitation therapy services. These widespread errors contribute to Medicare’s national payment error rate, as measured by the Comprehensive Error Rate Testing (CERT) program.
RT Welter & Associates offers ICD-10 Coder Academy
With the ICD-10 go-live date rapidly approaching, hospitals and health systems need to make ICD-10 a priority if they want to avoid costly surprises and setbacks. This is the message from RT Welter & Associates, Inc., which will hold an interactive and hands-on ICD-10 training designed to prepare coders for the AAPC and AHIMA ICD-10 proficiency examinations.
Participants will gain the tools they need to appropriately select ICD-10-CM and ICD-10-PCS codes. These training sessions will be coder-centric, and the content will be designed for those staff who will be responsible for applying (or verifying) these codes to documentation. Throughout the academy, participants will be given an assortment of scenarios to code to obtain the proficiency they need for coding in ICD-10.
Upcoming Coder Academies will be held March 12-14 in Englewood and June 11-13 in Thornton. Click here to read more information and to register. Colorado ICD-10 Coalition members can receive a $50 discount off the Coder Academy registration fee. Simply print the registration form, write "Colorado ICD-10 Coalition Member" on it and return through the instructions at the top of the form.
Participants will gain the tools they need to appropriately select ICD-10-CM and ICD-10-PCS codes. These training sessions will be coder-centric, and the content will be designed for those staff who will be responsible for applying (or verifying) these codes to documentation. Throughout the academy, participants will be given an assortment of scenarios to code to obtain the proficiency they need for coding in ICD-10.
Upcoming Coder Academies will be held March 12-14 in Englewood and June 11-13 in Thornton. Click here to read more information and to register. Colorado ICD-10 Coalition members can receive a $50 discount off the Coder Academy registration fee. Simply print the registration form, write "Colorado ICD-10 Coalition Member" on it and return through the instructions at the top of the form.
Available from AMA: Point-of-Care Pricing Toolkit:
Did you know that 48 percent of better-performing practices collect more than 90 percent of patient payments at the time of service?
See decreased accounts receivable and more cash flow in your practice immediately by collecting payment from patients at the time of service - before they walk out the door with the help of an AMA toolkit.
Learn how to use electronic health care transactions, such as the electronic eligibility benefit inquiry and response transactions, to help facilitate point-of-care pricing and improve cash flow. This toolkit will walk you through the process so your practice can start collecting from patients at the time of service! You can also learn more about electronic eligibility verification. Click here to access the AMA's toolkit and more.
See decreased accounts receivable and more cash flow in your practice immediately by collecting payment from patients at the time of service - before they walk out the door with the help of an AMA toolkit.
Learn how to use electronic health care transactions, such as the electronic eligibility benefit inquiry and response transactions, to help facilitate point-of-care pricing and improve cash flow. This toolkit will walk you through the process so your practice can start collecting from patients at the time of service! You can also learn more about electronic eligibility verification. Click here to access the AMA's toolkit and more.
MGMA: Federal CMS releases updated PQRS resources
The Centers for Medicare and Medicaid Services has released updated PQRS resources summarizing 2014 reporting requirements for the program. The PQRS program will apply a 2 percent penalty in 2016 to providers who do not meet reporting criteria in the 2014 performance year. In most cases, providers must report on at least three PQRS measures in 2014 to avoid the 2016 payment adjustment.
Click here to go to MGMA's PQRS resource page to learn more about how to avoid this penalty, and read MGMA's 2014 Final Medicare Physician Fee Schedule Analysis (reference pages 10-12).
Click here to go to MGMA's PQRS resource page to learn more about how to avoid this penalty, and read MGMA's 2014 Final Medicare Physician Fee Schedule Analysis (reference pages 10-12).
Meaningful Use attestation deadline extended to March 31
Eligible professionals must submit their Medicare EHR incentive (Meaningful Use) attestation by 9:59 p.m. MT on March 31 -- an extension from the original Feb. 28 deadline -- in order to earn a 2013 incentive payment and avoid a 1 percent penalty in 2015. The extension does not change deadlines for the Medicaid EHR incentive program or any other CMS reporting program.
The Centers for Medicare and Medicaid Services has provided the below tips on attesting:
Ensure that your payment assignment and other relevant information is up to date in the Medicare payment system PECOS
Make sure to include a valid email address in your EHR program registration
Consider logging on to use the attestation system during non-peak hours such as evenings and weekends
Log on to the registration and attestation system now and ensure that your information is up to date and begin entering your 2013 data
If you experience attestation problems, call the EHR Incentive Program Help Desk at 1-888-734-6433 (M-F 6:30 a.m. - 5:30 p.m. MT) and report the problem
If your organization has more than 1,000 providers assigned to a proxy user, use the PECOS system to designate additional proxies to facilitate attestation.
Click here to go to the federal CMS website to register or attest for the Medicare and/or Medicaid EHR Incentive Programs. Click here to go to MGMA's resource center to view Meaningful Use resources, such as a compilation of most-asked member questions.
The Centers for Medicare and Medicaid Services has provided the below tips on attesting:
Ensure that your payment assignment and other relevant information is up to date in the Medicare payment system PECOS
Make sure to include a valid email address in your EHR program registration
Consider logging on to use the attestation system during non-peak hours such as evenings and weekends
Log on to the registration and attestation system now and ensure that your information is up to date and begin entering your 2013 data
If you experience attestation problems, call the EHR Incentive Program Help Desk at 1-888-734-6433 (M-F 6:30 a.m. - 5:30 p.m. MT) and report the problem
If your organization has more than 1,000 providers assigned to a proxy user, use the PECOS system to designate additional proxies to facilitate attestation.
Click here to go to the federal CMS website to register or attest for the Medicare and/or Medicaid EHR Incentive Programs. Click here to go to MGMA's resource center to view Meaningful Use resources, such as a compilation of most-asked member questions.
WEDI to offer free ICD-10 compliance training through webinar series
First webinar to take place on Feb. 21
As part of the ICD-10 Success Initiative, WEDI announced the launch of its ICD-10 Success Initiative webinar series. The purpose of these webinars is to help health IT stakeholders meet the Oct. 1 ICD-10 compliance deadline and to provide answers to common questions.
The first webinar of this series, the Guide to Jumpstart Your ICD-10 Compliance Efforts, is free to attend and will take place on Feb. 21 at 9 a.m. MT. Participation is free; click here to register.
This webinar will present an overview on preparing for the Oct. 1 ICD-10 transition. Regardless of how far along organizations are in their implementation process, this webinar will cover all the bases, including steps to guarantee your documentation is upgraded; essential tactics to warrant that coders can code in ICD-10; confirming practice management systems can take in ICD-10; ensuring transactions can be produced with ICD-10; best practices on testing with trading partners; and the roll of the clearinghouse and what it can and cannot accomplish.
This webinar will feature speakers from the Cooperative Exchange as well as representatives from the Centers for Medicare and Medicaid Services. Click here to learn more about this webinar.
As part of the ICD-10 Success Initiative, WEDI announced the launch of its ICD-10 Success Initiative webinar series. The purpose of these webinars is to help health IT stakeholders meet the Oct. 1 ICD-10 compliance deadline and to provide answers to common questions.
The first webinar of this series, the Guide to Jumpstart Your ICD-10 Compliance Efforts, is free to attend and will take place on Feb. 21 at 9 a.m. MT. Participation is free; click here to register.
This webinar will present an overview on preparing for the Oct. 1 ICD-10 transition. Regardless of how far along organizations are in their implementation process, this webinar will cover all the bases, including steps to guarantee your documentation is upgraded; essential tactics to warrant that coders can code in ICD-10; confirming practice management systems can take in ICD-10; ensuring transactions can be produced with ICD-10; best practices on testing with trading partners; and the roll of the clearinghouse and what it can and cannot accomplish.
This webinar will feature speakers from the Cooperative Exchange as well as representatives from the Centers for Medicare and Medicaid Services. Click here to learn more about this webinar.
Fill out the CMGMA 2014 Salary Survey
It's that time of year again:
The Colorado Medical Society (CMS) has partnered with the Colorado Medical Group Management Association (CMGMA) again this year to bring you the 2014 Colorado Healthcare Staff Salary Survey. This survey is a continuation of the previous Salary Survey that has been conducted by the CMGMA, CMS and component medical societies across the state for over a decade and will be produced this year by CheckPoint. Continued financial support of the surveys is provided by COPIC Insurance and Colorado Business Bank.
To make these surveys successful, we need your help! These surveys are designed specifically for Colorado medical practices, and your participation is key to our success. Our goal is to accumulate data from all the geographical regions in Colorado and then report the data based on these regions.
The Salary Survey tool is online at www.checkpoint.cmgma.com. This link will take you to a login page but please note that the survey is open to everyone. CMGMA members can log in as usual and complete the survey. Non-CMGMA members can click on the New User link below Member login to sign up to take the survey.
The objective of this survey is to provide Colorado physicians, administrators, and managers with a useful resource that is representative of their local area to set salary and benefit levels within their practices. Having reports at your fingertips that contain salary and benefit benchmarks are critical tools to help practices be effective and competitive in the marketplace.
Please fill out the questions completely and accurately, as quality data is essential to the process.
Your completed questionnaire is due by Friday, April 18, 2014 and the report will be available in June 2014.
There will be a couple of drawings again this year from all responses received as of that date for a Visa gift card, so be sure to return your questionnaire early and have more chances to win!
All participating practices will receive a FREE copy of the 2014 Staff Salary Survey Report. This report is also available for purchase.
If you have any questions about the survey content itself please contact Eric Speer, chair of the CMGMA Survey Committee at (719) 265-3737 or espeer@dublinprimarycare.com. We appreciate your time, and value your participation.
The Colorado Medical Society (CMS) has partnered with the Colorado Medical Group Management Association (CMGMA) again this year to bring you the 2014 Colorado Healthcare Staff Salary Survey. This survey is a continuation of the previous Salary Survey that has been conducted by the CMGMA, CMS and component medical societies across the state for over a decade and will be produced this year by CheckPoint. Continued financial support of the surveys is provided by COPIC Insurance and Colorado Business Bank.
To make these surveys successful, we need your help! These surveys are designed specifically for Colorado medical practices, and your participation is key to our success. Our goal is to accumulate data from all the geographical regions in Colorado and then report the data based on these regions.
The Salary Survey tool is online at www.checkpoint.cmgma.com. This link will take you to a login page but please note that the survey is open to everyone. CMGMA members can log in as usual and complete the survey. Non-CMGMA members can click on the New User link below Member login to sign up to take the survey.
The objective of this survey is to provide Colorado physicians, administrators, and managers with a useful resource that is representative of their local area to set salary and benefit levels within their practices. Having reports at your fingertips that contain salary and benefit benchmarks are critical tools to help practices be effective and competitive in the marketplace.
Please fill out the questions completely and accurately, as quality data is essential to the process.
Your completed questionnaire is due by Friday, April 18, 2014 and the report will be available in June 2014.
There will be a couple of drawings again this year from all responses received as of that date for a Visa gift card, so be sure to return your questionnaire early and have more chances to win!
All participating practices will receive a FREE copy of the 2014 Staff Salary Survey Report. This report is also available for purchase.
If you have any questions about the survey content itself please contact Eric Speer, chair of the CMGMA Survey Committee at (719) 265-3737 or espeer@dublinprimarycare.com. We appreciate your time, and value your participation.
Stroke Coordinatior Conference
Your Role as a Stroke Coordinator: From Surviving to Thriving will equip Stroke Coordinators with the education, tools and resources they need to run a successful stroke program. Attendees will be educated in key components of the role, giving them the tools they need to build and maintain successful programs and to assist in building a network of their peers. With proper education and tools, we believe that Stroke Coordinators will be more satisfied, successful and will remain in their positions longer. The American Heart Association designates the maximum number of hours awarded for this CE activity is 8.50 contact hours.
For full details and registration click here:
Medicare News Part A
Medicare News
Part A Top Claim Submission Errors - January 2014
The Part A Top Claim Submission Errors for January 2014 have been posted. Please review resolutions to the errors that may impact you.
Upcoming Events
Join us for our webinar "Part A Credit Balance" on February 21, 2014 (10:00am ET/9:00am CT).
We will describe the credit balance report, help you understand when and where to submit the credit balance report, and examine how to submit a voluntary refund.
Don't miss this informative event! Register today, and download the handout.
Join us for our webinar "Part A Ambulance Services" on February 27, 2014 (2:00pm ET/1:00pm CT).
We will discuss common errors relating to ambulance services, explore current ambulance updates and reminders, provide an overview of Comprehensive Error Rate Testing (CERT) program, and educate about valuable resources and references.
Register today for this informative event! Get the handout here.
“Updated Mobile Applications (Apps) for Open Payments” MLN Matters® Article — Released
MLN Matters® Special Edition Article #SE1402, “Updated Mobile Applications (Apps) for Open Payments” was released and is now available in a downloadable format. This article is designed to provide education on updates to the mobile applications (apps), Open Payments Mobile for Industry and Open Payments Mobile for Physicians, implemented as a result of user feedback to CMS. It includes detailed information on recent enhancements to the apps and provides additional resources for technical support. For more information on Open Payments and the mobile app, please see the program website at http://go.cms.gov/openpayments.
Part A Top Claim Submission Errors - January 2014
The Part A Top Claim Submission Errors for January 2014 have been posted. Please review resolutions to the errors that may impact you.
Upcoming Events
Join us for our webinar "Part A Credit Balance" on February 21, 2014 (10:00am ET/9:00am CT).
We will describe the credit balance report, help you understand when and where to submit the credit balance report, and examine how to submit a voluntary refund.
Don't miss this informative event! Register today, and download the handout.
Join us for our webinar "Part A Ambulance Services" on February 27, 2014 (2:00pm ET/1:00pm CT).
We will discuss common errors relating to ambulance services, explore current ambulance updates and reminders, provide an overview of Comprehensive Error Rate Testing (CERT) program, and educate about valuable resources and references.
Register today for this informative event! Get the handout here.
“Updated Mobile Applications (Apps) for Open Payments” MLN Matters® Article — Released
MLN Matters® Special Edition Article #SE1402, “Updated Mobile Applications (Apps) for Open Payments” was released and is now available in a downloadable format. This article is designed to provide education on updates to the mobile applications (apps), Open Payments Mobile for Industry and Open Payments Mobile for Physicians, implemented as a result of user feedback to CMS. It includes detailed information on recent enhancements to the apps and provides additional resources for technical support. For more information on Open Payments and the mobile app, please see the program website at http://go.cms.gov/openpayments.
Medicare News Part B
Medicare News
Upcoming Event
Join us for our webinar "Ambulance Services" on February 28, 2014 (10:00am ET/9:00am CT).
We will discuss common errors relating to ambulance services, explore current ambulance updates and reminders, review the highlights from Medical Review and Appeals, provide an overview of the Comprehensive Error Rate Testing (CERT) program, and educate about valuable resources and references.
Register today for this informative event! Download the handout now!
“Updated Mobile Applications (Apps) for Open Payments” MLN Matters® Article — Released
MLN Matters® Special Edition Article #SE1402, “Updated Mobile Applications (Apps) for Open Payments” was released and is now available in a downloadable format. This article is designed to provide education on updates to the mobile applications (apps), Open Payments Mobile for Industry and Open Payments Mobile for Physicians, implemented as a result of user feedback to CMS. It includes detailed information on recent enhancements to the apps and provides additional resources for technical support. For more information on Open Payments and the mobile app, please see the program website at http://go.cms.gov/openpayments.
Upcoming Event
Join us for our webinar "Ambulance Services" on February 28, 2014 (10:00am ET/9:00am CT).
We will discuss common errors relating to ambulance services, explore current ambulance updates and reminders, review the highlights from Medical Review and Appeals, provide an overview of the Comprehensive Error Rate Testing (CERT) program, and educate about valuable resources and references.
Register today for this informative event! Download the handout now!
“Updated Mobile Applications (Apps) for Open Payments” MLN Matters® Article — Released
MLN Matters® Special Edition Article #SE1402, “Updated Mobile Applications (Apps) for Open Payments” was released and is now available in a downloadable format. This article is designed to provide education on updates to the mobile applications (apps), Open Payments Mobile for Industry and Open Payments Mobile for Physicians, implemented as a result of user feedback to CMS. It includes detailed information on recent enhancements to the apps and provides additional resources for technical support. For more information on Open Payments and the mobile app, please see the program website at http://go.cms.gov/openpayments.
Wednesday, February 19, 2014
CREATE Stakeholder Call (Part 2) - Friday
Attention CREATE Participants and Interested Parties
You are personally invited to join us for a CREATE stakeholder call on Friday, February 21st at 1:00 p.m. This is your opportunity to be a part of the process, as we prepare for programmatic updates to The Colorado Resource for Emergency and Trauma Education (CREATE) grant program.
· WHY THIS IS IMPORTANT: As the program continues to experience successful growth, now more than ever is the time to discuss the scoring tool and the cut off for a pass/fail score.
· Why We Need Your Support: Stakeholder input and discussions are extremely important before recommendations are made to SEMTAC (State Emergency and Trauma Advisory Council) for approval.
· Background Information: The lowest average score has been 28 out of 50 points possible and the highest passing score has been 45.75 out of 50 points possible. The average passing score has been in the mid to high 30 points range (35 or above).
To register for these meetings: Dial-In Number: U.S. & Canada: 866.740.1260 Access Code: 5655847
Ready Talk Registration Link: https://cc.readytalk.com/cc/s/registrations/new?cid=3flijp96w947
You are personally invited to join us for a CREATE stakeholder call on Friday, February 21st at 1:00 p.m. This is your opportunity to be a part of the process, as we prepare for programmatic updates to The Colorado Resource for Emergency and Trauma Education (CREATE) grant program.
· WHY THIS IS IMPORTANT: As the program continues to experience successful growth, now more than ever is the time to discuss the scoring tool and the cut off for a pass/fail score.
· Why We Need Your Support: Stakeholder input and discussions are extremely important before recommendations are made to SEMTAC (State Emergency and Trauma Advisory Council) for approval.
· Background Information: The lowest average score has been 28 out of 50 points possible and the highest passing score has been 45.75 out of 50 points possible. The average passing score has been in the mid to high 30 points range (35 or above).
To register for these meetings: Dial-In Number: U.S. & Canada: 866.740.1260 Access Code: 5655847
Ready Talk Registration Link: https://cc.readytalk.com/cc/s/registrations/new?cid=3flijp96w947
Tuesday, February 18, 2014
Stage 2 of Meaningful Use?
New CMS and ONC Tool Enables Providers to Meet Transitions of Care Measure
Are you a provider who is demonstrating Stage 2 of meaningful use? If so, a new CMS and ONC tool called the Randomizer will let you exchange data with a Test EHR in order to meet measure #3 of the Stage 2 transitions of care requirement.
The transitions of care requirement for eligible professionals and eligible hospitals includes three measures. Measure #3 is outlined below:
Conduct one or more successful electronic exchanges of a summary of care document with a recipient who has EHR technology that was developed by a different EHR technology developer than yours, or
Conduct one or more successful tests with the CMS designated test EHR during the EHR reporting period.
How to Use the Tool
To use the tool to meet this measure, you must register with EHR Randomizer. Once registered, it will pair your EHR technology with a different test EHR from the list of authorized systems. You must then send a Consolidated Clinical Document Architecture (CCDA) summary of care record to the Test EHR. CMS and ONC recommend that you send a test CCDA document that does not contain actual patient information.
Test EHRs will be required to email you within one day of the test, with notification of success or failure. A notification of a successful test can be used as proof of meeting the transitions of care measure.
Refer to the Randomizer Test Instructions and FAQs for more information.
Are you a provider who is demonstrating Stage 2 of meaningful use? If so, a new CMS and ONC tool called the Randomizer will let you exchange data with a Test EHR in order to meet measure #3 of the Stage 2 transitions of care requirement.
The transitions of care requirement for eligible professionals and eligible hospitals includes three measures. Measure #3 is outlined below:
Conduct one or more successful electronic exchanges of a summary of care document with a recipient who has EHR technology that was developed by a different EHR technology developer than yours, or
Conduct one or more successful tests with the CMS designated test EHR during the EHR reporting period.
How to Use the Tool
To use the tool to meet this measure, you must register with EHR Randomizer. Once registered, it will pair your EHR technology with a different test EHR from the list of authorized systems. You must then send a Consolidated Clinical Document Architecture (CCDA) summary of care record to the Test EHR. CMS and ONC recommend that you send a test CCDA document that does not contain actual patient information.
Test EHRs will be required to email you within one day of the test, with notification of success or failure. A notification of a successful test can be used as proof of meeting the transitions of care measure.
Refer to the Randomizer Test Instructions and FAQs for more information.
Important Medicare A
February 13, 2014
System Alerts
Part A 04911 Production Availability
The Part A 04911 Production Region will NOT be available on Saturday, 02/15/14 due to systems maintenance. We apologize for any inconvenience this may cause.
Medicare News
CMS MLN Connects Provider e-News
The February 13, 2014 edition of the MLN Connects Provider e-News * is now available.
Please take note of the articles included in the Claims, Pricers and Codes section of this edition:
Hold for Hospice Claims Containing a Service Facility NPI
Reprocessing of Air Ambulance Claims
CY 2014 HH PPS Mainframe Pricer Software Now Available
Upcoming Event
Join us for our webinar "Part A CMS Final Rule 1599-F: Understanding Inpatient Admission and Reviews (Two-Midnight Rule)" on February 24, 2014 (2:00pm ET/1:00pm CT).
We will provide education on the inpatient admission review process, help you understand the two midnight benchmark, and review the guidelines for an admission order and physician certification.
Don't miss this informative event! Register today, or get the handout!
February 14, 2014
Hardcopy Claim Submissions including Adjustments and Cancels
Novitas Solutions would like to remind our providers about hardcopy claim adjustments and cancels, the ability to submit adjustments and cancels electronically on claims that include denied services (without altering the denied item), and the importance of including Remarks.
System Alerts
Part A 04911 Production Availability
The Part A 04911 Production Region will NOT be available on Saturday, 02/15/14 due to systems maintenance. We apologize for any inconvenience this may cause.
Medicare News
CMS MLN Connects Provider e-News
The February 13, 2014 edition of the MLN Connects Provider e-News * is now available.
Please take note of the articles included in the Claims, Pricers and Codes section of this edition:
Hold for Hospice Claims Containing a Service Facility NPI
Reprocessing of Air Ambulance Claims
CY 2014 HH PPS Mainframe Pricer Software Now Available
Upcoming Event
Join us for our webinar "Part A CMS Final Rule 1599-F: Understanding Inpatient Admission and Reviews (Two-Midnight Rule)" on February 24, 2014 (2:00pm ET/1:00pm CT).
We will provide education on the inpatient admission review process, help you understand the two midnight benchmark, and review the guidelines for an admission order and physician certification.
Don't miss this informative event! Register today, or get the handout!
February 14, 2014
Hardcopy Claim Submissions including Adjustments and Cancels
Novitas Solutions would like to remind our providers about hardcopy claim adjustments and cancels, the ability to submit adjustments and cancels electronically on claims that include denied services (without altering the denied item), and the importance of including Remarks.
Important Medicare B
February 13, 2014
CMS MLN Connects Provider e-News
e-News * is now available.
Please take note of the articles included in the Claims, Pricers and Codes section of this edition:
Hold for Hospice Claims Containing a Service Facility NPI
Reprocessing of Air Ambulance Claims
CY 2014 HH PPS Mainframe Pricer Software Now Available
February 14, 2014
DME MAC "Dear Physician" Letters – Documentation Requirements
Are you a physician who orders durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS)? This article contains information and resources on documentation and medical necessity requirements. Make sure to review the "Dear Physician" letters published by the DME MACs. A link can be found in this article.
Website Navigation Frequently Asked Questions
Need help navigating our website? Please check out our Website Navigation Frequently Asked Questions.
CMS MLN Connects Provider e-News
e-News * is now available.
Please take note of the articles included in the Claims, Pricers and Codes section of this edition:
Hold for Hospice Claims Containing a Service Facility NPI
Reprocessing of Air Ambulance Claims
CY 2014 HH PPS Mainframe Pricer Software Now Available
February 14, 2014
DME MAC "Dear Physician" Letters – Documentation Requirements
Are you a physician who orders durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS)? This article contains information and resources on documentation and medical necessity requirements. Make sure to review the "Dear Physician" letters published by the DME MACs. A link can be found in this article.
Website Navigation Frequently Asked Questions
Need help navigating our website? Please check out our Website Navigation Frequently Asked Questions.
Telemedicine Training Conference
Flagstaff Medical Center’s McGee Auditorium
1200 N. Beaver St., Flagstaff, AZ
Tuesday, April 1, 2014 9 a.m. – 5 p.m.
For More details and registration click here:
1200 N. Beaver St., Flagstaff, AZ
Tuesday, April 1, 2014 9 a.m. – 5 p.m.
For More details and registration click here:
Arizona Telemedicine:
Helping Cardiologists in Tucson Save Babies in Yuma
Neonatologist Greg Warda, MD, arrived at Yuma Regional Medical Center 15 years ago, the hospital's only full-time neonatologist, and medical director of its neonatal intensive-care unit.
Back then, Warda's most urgent challenge was determining when a sick baby could remain in the Yuma hospital or needed to be transported to a larger hospital where multiple specialists could oversee the baby's care.
Read more »
Neonatologist Greg Warda, MD, arrived at Yuma Regional Medical Center 15 years ago, the hospital's only full-time neonatologist, and medical director of its neonatal intensive-care unit.
Back then, Warda's most urgent challenge was determining when a sick baby could remain in the Yuma hospital or needed to be transported to a larger hospital where multiple specialists could oversee the baby's care.
Read more »
Medicare A
Medicare News
Upcoming Events!
Join us for our webinar "Part A/B New and Small Provider Education - Part 1 Medicare Basics" on February 25, 2014 (10:00am ET/9:00am CT).
We will provide basic information on the Medicare Program, discuss Medicare covered services and items not covered under the Medicare program, review Medicare reimbursement guidelines, and speak about the role of Novitas Solutions.
Don't miss this informative event! Register today, or download the handout now!
Medicare Learning Network Matters Articles from CMS
New:
MM8526 – Medicare National Coverage Determination (NCD) for Beta Amyloid Positron Emission Tomography (PET) in Dementia and Neurodegenerative Disease
MM8525 – National Coverage Determination (NCD) for Single Chamber and Dual Chamber Permanent Cardiac Pacemakers
MM8468 – Fluorodeoxyglucose (FDG) Positron Emission Tomography (PET) for Solid Tumors
Upcoming Events!
Join us for our webinar "Part A/B New and Small Provider Education - Part 1 Medicare Basics" on February 25, 2014 (10:00am ET/9:00am CT).
We will provide basic information on the Medicare Program, discuss Medicare covered services and items not covered under the Medicare program, review Medicare reimbursement guidelines, and speak about the role of Novitas Solutions.
Don't miss this informative event! Register today, or download the handout now!
Medicare Learning Network Matters Articles from CMS
New:
MM8526 – Medicare National Coverage Determination (NCD) for Beta Amyloid Positron Emission Tomography (PET) in Dementia and Neurodegenerative Disease
MM8525 – National Coverage Determination (NCD) for Single Chamber and Dual Chamber Permanent Cardiac Pacemakers
MM8468 – Fluorodeoxyglucose (FDG) Positron Emission Tomography (PET) for Solid Tumors
Medicare B
Medicare News
Upcoming Events!
Join us for our webinar "Part A/B New and Small Provider Education - Part 1 Medicare Basics" on February 25, 2014 (10:00am ET/9:00am CT).
We will provide basic information on the Medicare Program, discuss Medicare covered services and items not covered under the Medicare program, review Medicare reimbursement guidelines, and speak about the role of Novitas Solutions.
Don't miss this informative event! Register today, or download the handout now!
Evaluation and Management Score Sheet Part Three-Using the Score Sheet-February 19, 2014 (2:00pm-3:00pm ET, 1:00pm- 2:00pm CT)
Register Today, and download the handout now!
Evaluation and Management Score Sheet Part Four: Scoring Medical Records Using the Score Sheet- February 26, 2014 (2:00pm-3:00pm ET, 1:00pm-2:00pm CT)
Register Today, and download the handout now!
If you miss any part of the series, it will be presented again the following month in the same order.
The series will consist of the following:
•Week One-Part One- Understanding the Key components of Evaluation and Management.
•Week Two-Part Two- Introduction to the Score Sheet,
•Week Three- Part Three- Using the Score Sheet
•Week Four- Part Four- Scoring Medical Records Using the Score Sheet.
If you are new to documenting and/or scoring evaluation and management services, this webinar event is for you. You must attend this event. Don't miss it, register today!
Medicare Learning Network Matters Articles from CMS
New:
MM8526 – Medicare National Coverage Determination (NCD) for Beta Amyloid Positron Emission Tomography (PET) in Dementia and Neurodegenerative Disease
MM8525 – National Coverage Determination (NCD) for Single Chamber and Dual Chamber Permanent Cardiac Pacemakers
MM8468 – Fluorodeoxyglucose (FDG) Positron Emission Tomography (PET) for Solid Tumors
Upcoming Events!
Join us for our webinar "Part A/B New and Small Provider Education - Part 1 Medicare Basics" on February 25, 2014 (10:00am ET/9:00am CT).
We will provide basic information on the Medicare Program, discuss Medicare covered services and items not covered under the Medicare program, review Medicare reimbursement guidelines, and speak about the role of Novitas Solutions.
Don't miss this informative event! Register today, or download the handout now!
Evaluation and Management Score Sheet Part Three-Using the Score Sheet-February 19, 2014 (2:00pm-3:00pm ET, 1:00pm- 2:00pm CT)
Register Today, and download the handout now!
Evaluation and Management Score Sheet Part Four: Scoring Medical Records Using the Score Sheet- February 26, 2014 (2:00pm-3:00pm ET, 1:00pm-2:00pm CT)
Register Today, and download the handout now!
If you miss any part of the series, it will be presented again the following month in the same order.
The series will consist of the following:
•Week One-Part One- Understanding the Key components of Evaluation and Management.
•Week Two-Part Two- Introduction to the Score Sheet,
•Week Three- Part Three- Using the Score Sheet
•Week Four- Part Four- Scoring Medical Records Using the Score Sheet.
If you are new to documenting and/or scoring evaluation and management services, this webinar event is for you. You must attend this event. Don't miss it, register today!
Medicare Learning Network Matters Articles from CMS
New:
MM8526 – Medicare National Coverage Determination (NCD) for Beta Amyloid Positron Emission Tomography (PET) in Dementia and Neurodegenerative Disease
MM8525 – National Coverage Determination (NCD) for Single Chamber and Dual Chamber Permanent Cardiac Pacemakers
MM8468 – Fluorodeoxyglucose (FDG) Positron Emission Tomography (PET) for Solid Tumors
Check out! Live Healthy Webinars
Preventing Diabetes and Heart Disease: Lifestyle Approaches
February 25, Tuesday, 4-5 p.m
Mediterranean Diet for Heart Health
March 18, Tuesday, 11 a.m.-Noon
"Heart and Sole" of Health
March 12, Wednesday, Noon-1 p.m.
Just to Name a few......Click here to get a complete list of webinars and to register.
February 25, Tuesday, 4-5 p.m
Mediterranean Diet for Heart Health
March 18, Tuesday, 11 a.m.-Noon
"Heart and Sole" of Health
March 12, Wednesday, Noon-1 p.m.
Just to Name a few......Click here to get a complete list of webinars and to register.
Friday, February 14, 2014
Medicare News Part A
Medicare Learning Network Matters Articles from CMS
New:
SE1408 – Medicare Fee-For-Service (FFS) Claims Processing Guidance for Implementing International Classification of Diseases, 10th Edition (ICD-10) – A Re-Issue of MM7492
Revised:
MM8494 – Changes to the Laboratory National Coverage Determination (NCD) Software for ICD-10 Codes
CMS MLN Connects Provider e-News
The February 6, 2014 edition of the MLN Connects Provider e-News * is now available.
Please take note of the articles included in the Claims, Pricers and Codes section of this edition:
Notification Regarding the New Benefits Coordination & Recovery Center
Claims Hold for ESRD Facilities that Waived Full PPS Payment
Upcoming Events
Part A Webinar Handout: "Part A Preventive Services" - February 11, 2014 (9:00am-10:30am CT)
Join us for our webinar "Part A Preventive Services" on February 11, 2014 (9:00am CT).
We will explain the coverage guidelines for a better understanding of preventive services, demonstrate where to find valuable information, and discuss the importance of the Comprehensive Error Rate Testing (CERT) Program.
Don't miss this informative event! Register today!
New:
SE1408 – Medicare Fee-For-Service (FFS) Claims Processing Guidance for Implementing International Classification of Diseases, 10th Edition (ICD-10) – A Re-Issue of MM7492
Revised:
MM8494 – Changes to the Laboratory National Coverage Determination (NCD) Software for ICD-10 Codes
CMS MLN Connects Provider e-News
The February 6, 2014 edition of the MLN Connects Provider e-News * is now available.
Please take note of the articles included in the Claims, Pricers and Codes section of this edition:
Notification Regarding the New Benefits Coordination & Recovery Center
Claims Hold for ESRD Facilities that Waived Full PPS Payment
Upcoming Events
Part A Webinar Handout: "Part A Preventive Services" - February 11, 2014 (9:00am-10:30am CT)
Join us for our webinar "Part A Preventive Services" on February 11, 2014 (9:00am CT).
We will explain the coverage guidelines for a better understanding of preventive services, demonstrate where to find valuable information, and discuss the importance of the Comprehensive Error Rate Testing (CERT) Program.
Don't miss this informative event! Register today!
Medicare News
Medicare Learning Network Matters Articles from CMS
New:
SE1408 – Medicare Fee-For-Service (FFS) Claims Processing Guidance for Implementing International Classification of Diseases, 10th Edition (ICD-10) – A Re-Issue of MM7492
Revised:
MM8494 – Changes to the Laboratory National Coverage Determination (NCD) Software for ICD-10 Codes
CMS MLN Connects Provider e-News
The February 6, 2014 edition of the MLN Connects Provider e-News * is now available.
Please take note of the articles included in the Claims, Pricers and Codes section of this edition:
Notification Regarding the New Benefits Coordination & Recovery Center
Claims Hold for ESRD Facilities that Waived Full PPS Payment
New:
SE1408 – Medicare Fee-For-Service (FFS) Claims Processing Guidance for Implementing International Classification of Diseases, 10th Edition (ICD-10) – A Re-Issue of MM7492
Revised:
MM8494 – Changes to the Laboratory National Coverage Determination (NCD) Software for ICD-10 Codes
CMS MLN Connects Provider e-News
The February 6, 2014 edition of the MLN Connects Provider e-News * is now available.
Please take note of the articles included in the Claims, Pricers and Codes section of this edition:
Notification Regarding the New Benefits Coordination & Recovery Center
Claims Hold for ESRD Facilities that Waived Full PPS Payment
Wednesday, February 12, 2014
18 Heuristics of CREATE Grant Writing:
“We are not grant writers”, is a statement heard very often at CREATE Grant Writing workshops and outreach events. In fact, grant writing can be a little intimidating at times for many EMS providers. CREATE staff wants every EMS provider to have an informative grant experience with CREATE, that in many cases can help them better understand grant writing, grant guidelines and eligibility that they may use in other grant program applications. The five “rule of thumb” items listed on this list will help guide you in ensuring your application is clearly communicating and justifying your need to the audience, or in this case, the ERC (Expert Review Committee). Of course this is not a full list of heuristics for grant writing, in fact the list is more comprehensive but this list incorporates excellent support in navigating the CREATE application process successfully to the review stage for non-experienced grant writers who want to make sure they are justifying their need to the review committee effectively. For more ideas to make your grant writing experience impactful, contact CREATE staff at 720.248.2742 or by email at lj@coruralhealth.org.
List of 18 CREATE Heuristic Ideas For Grant Writing:
• Detail all the commitments made by partners.
• Be very specific/detailed/clear/concise in each narrative section of the application
• Present a reasonable strategic timeline and supportive budget with justifications of large reserves explained clearly.
• Allow room for anticipated change – Expect the
unexpected.
• Be consistent with budgeted costs.
• Add in costs to your budget narratives
• Relationship building is what sets winning proposals apart from others.
• Research, Research, Research – cite underlying rational using quantitative data analysis and longitudinal studies.
•Be proactive not reactive.
•Follow grant guidelines – write to the audience.
• Demonstrate passion through authenticity.
• Connect all proposal elements – do not set up the proposal in fragments (Flow).
• Ask yourself and your organizations leadership what is needed to accomplish your goals.
• Have others review your proposal for objective criticism prior to submission.
• After being granted the award, continue communication with the funding source program manager to ensure report deadlines are met and all your questions are answered to ensure a smooth reimbursement
• Keep your proposal simple.
• Read the grant guidelines over and over again to ensure you understand all elements of the grant process and eligibility requirements.
• Ask for help from CREATE staff when things are not clearly understood or guidance is needed. WE ARE HERE TO HELP!
The Role of Palliative Care in Care Transitions
| Webinar: February 19th, 12:00-1:00 MT Hosted by the Center for Improving Value in Health Care Palliative care can be a critical component in the care transition process for patients with severe or life-limiting illness. The provision of palliative care, whether in-patient or post-discharge, can ensure that patients' symptoms are managed and they have support managing their illness across settings. Palliative care offers physical and emotional support for patients and caregivers and gives patients a place to turn before heading back to the emergency room. Click Here for Free Registration |
Tuesday, February 11, 2014
Medicare Part A Newsletter
January 2014
The January 2014 Medicare Part A Newsletter is now available! Please take a few moments to review.
1099 IRS Forms
Novitas Issued 2013 IRS 1099-INT Forms
Novitas has identified an issue with approximately 225 of the 2013 IRS 1099 forms mailed in late January. For those providers who received interest on claim payments from Novitas during 2013 that exceeded $600 of total interest paid, we will be mailing you a 1099-INT form in the next week. Consistent with IRS regulation, those providers who were paid less than $600 in interest will not be receiving a 1099-INT form. We apologize for any inconvenience this late issuance may cause. If you have any questions, please call our 1099 representative at (904) 791-6529 or email us at novitas1099@fcso.com.
Novitas has identified an issue with approximately 225 of the 2013 IRS 1099 forms mailed in late January. For those providers who received interest on claim payments from Novitas during 2013 that exceeded $600 of total interest paid, we will be mailing you a 1099-INT form in the next week. Consistent with IRS regulation, those providers who were paid less than $600 in interest will not be receiving a 1099-INT form. We apologize for any inconvenience this late issuance may cause. If you have any questions, please call our 1099 representative at (904) 791-6529 or email us at novitas1099@fcso.com.
Network Matters Articles
Medicare Learning Network Matters Articles from CMS
New:
SE1305 – Full Implementation of Edits on the Ordering/Referring Providers in Medicare Part B, DME, and Part A Home Health Agency (HHA) Claims (Change Requests 6417, 6421, 6696, and 6856)
Rescinded:
SE1407 – Psychiatry and Psychotherapy Services
New:
SE1305 – Full Implementation of Edits on the Ordering/Referring Providers in Medicare Part B, DME, and Part A Home Health Agency (HHA) Claims (Change Requests 6417, 6421, 6696, and 6856)
Rescinded:
SE1407 – Psychiatry and Psychotherapy Services
Medicare Insights Weekly
Medicare News
Medicare Insights Weekly Podcasts are back!
Have you missed us? We took the time away to make our podcasts better for you. If you listened to our podcasts in the past, welcome back! If you haven't listened, now is a great time to start!
This week, we discuss the Advance Beneficiary Notice of Non-coverage for outpatient therapy services at length.
Last week, Medicare Insights Weekly Podcasts reviewed the timely filing requirements. Do you really know how long you have to file a claim to Medicare? Listen to our podcast to find out!
Don't miss an episode! Listen today!
Medicare Insights Weekly Podcasts are back!
Have you missed us? We took the time away to make our podcasts better for you. If you listened to our podcasts in the past, welcome back! If you haven't listened, now is a great time to start!
This week, we discuss the Advance Beneficiary Notice of Non-coverage for outpatient therapy services at length.
Last week, Medicare Insights Weekly Podcasts reviewed the timely filing requirements. Do you really know how long you have to file a claim to Medicare? Listen to our podcast to find out!
Don't miss an episode! Listen today!
CPT Codes
System Alert Update
CPT Codes 90661 or 90688 denied for FDA approval or Performed by a Centralized Biller
UPDATE: (2/10/14 @ 4:30 PM)
All adjustments have been initiated as of February 7, 2014.
ISSUED: (01/29/14 @ 2:58 PM)
Services billed for Current Procedural Terminology (CPT) codes 90661 or 90688 were incorrectly denied for either Federal Food and Drug Administration (FDA) approval or based on performance by a Centralized biller.
CPT codes 90661 and 90688 have received FDA approval status effective November 20, 2012 and August 16, 2013 respectively. Due to untimely receipt of this information and subsequent updating of our internal files, claims denied incorrectly. The denial messages would be Claim Adjustment Reason Code (CARC) 114 (not FDA approved) or 170 (preformed by this provider).
CPT Codes 90661 or 90688 denied for FDA approval or Performed by a Centralized Biller
UPDATE: (2/10/14 @ 4:30 PM)
All adjustments have been initiated as of February 7, 2014.
ISSUED: (01/29/14 @ 2:58 PM)
Services billed for Current Procedural Terminology (CPT) codes 90661 or 90688 were incorrectly denied for either Federal Food and Drug Administration (FDA) approval or based on performance by a Centralized biller.
CPT codes 90661 and 90688 have received FDA approval status effective November 20, 2012 and August 16, 2013 respectively. Due to untimely receipt of this information and subsequent updating of our internal files, claims denied incorrectly. The denial messages would be Claim Adjustment Reason Code (CARC) 114 (not FDA approved) or 170 (preformed by this provider).
Thursday, February 6, 2014
Medicare News
Expanding Customer Service Hours - February 3, 2014
In response to the high wait time to speak with a Customer Service Representative, we are expanding our hours of operation to better serve you. Effective February 3, 2014, our lines will open one hour earlier at 7:00 am CT. Please accept our apologies and be assured that we are working diligently to resolve this issue. We appreciate your patience.
Upcoming Events
JH Part B Webinar Handout: "Evaluation and Management Score Sheet Part 2- Introduction to the Score Sheet"-February 12, 2014 (1:00pm-2:00pm CT)
Join us for "Part Two-Understanding the Score Sheet" of the new series on Evaluation and Management Services. This four part series was developed to increase your understanding of evaluation and management services. The complete series will be presented every month with one part each week. It is recommended to take the entire series in order to maximize your understanding. However, if you miss any part of the series, it will be presented again the following month in the same order.
The series will consist of the following:
•Week One-Part One- Understanding the Key components of Evaluation and Management.
•Week Two-Part Two- Introduction to the Score Sheet,
•Week Three- Part Three- Using the Score Sheet
•Week Four- Part Four- Scoring Medical Records Using the Score Sheet.
If you are new to documenting and/or scoring evaluation and management services, this webinar event is for you. You must attend this event. Don't miss it, register today!
In response to the high wait time to speak with a Customer Service Representative, we are expanding our hours of operation to better serve you. Effective February 3, 2014, our lines will open one hour earlier at 7:00 am CT. Please accept our apologies and be assured that we are working diligently to resolve this issue. We appreciate your patience.
Upcoming Events
JH Part B Webinar Handout: "Evaluation and Management Score Sheet Part 2- Introduction to the Score Sheet"-February 12, 2014 (1:00pm-2:00pm CT)
Join us for "Part Two-Understanding the Score Sheet" of the new series on Evaluation and Management Services. This four part series was developed to increase your understanding of evaluation and management services. The complete series will be presented every month with one part each week. It is recommended to take the entire series in order to maximize your understanding. However, if you miss any part of the series, it will be presented again the following month in the same order.
The series will consist of the following:
•Week One-Part One- Understanding the Key components of Evaluation and Management.
•Week Two-Part Two- Introduction to the Score Sheet,
•Week Three- Part Three- Using the Score Sheet
•Week Four- Part Four- Scoring Medical Records Using the Score Sheet.
If you are new to documenting and/or scoring evaluation and management services, this webinar event is for you. You must attend this event. Don't miss it, register today!
CREATE Stakeholder Calls.
Attention CREATE Participants and Interested Parties,
You are personally invited to join us for CREATE stakeholder calls. This is your opportunity to be a part of the process, as we prepare for programmatic updates of The Colorado Resource for Emergency and Trauma Education (CREATE) grant program. There will be two upcoming stakeholder conference calls to discuss the most important part of an application review, the scoring tool. All previous, and current grantees are encouraged to join the call. Your opinion counts….and we want to hear from you!
1st Stakeholder Call: Friday, February 7th, 2014 at 1 p.m.
2nd Stakeholder Call: Friday, February 21st, 2014 at 1 p.m.
To register for this Friday’s meeting, please click here. The call will begin promptly at 1p.m. Pre-registration is encouraged in order to receive documents for discussion prior to the meeting. For more information, contact Lakesha Jones at (720) 248-2742.
To See complete flyer click here.
Critical Access Hospital Relief Act
Introduced Regarding 96-Hour Certification
Representative Adrian Smith (R-NE) has introduced the Critical Access Hospital Relief Act (H.R. 3991). This bill, which is cosponsored by Representatives Lynn Jenkins (R-KS), Greg Walden (R-OR), and David Loebsack (D-IA), would eliminate the current Condition of Payment requirement that physicians at Critical Access Hospitals certify, at the time of admission, that Medicare and Medicaid patients will not be at the facility for more than 96 hours. The legislation would not remove the requirement that CAHs maintain an average annual length of stay of 96 hours, nor affect other certification requirements for hospitals.
Representative Adrian Smith (R-NE) has introduced the Critical Access Hospital Relief Act (H.R. 3991). This bill, which is cosponsored by Representatives Lynn Jenkins (R-KS), Greg Walden (R-OR), and David Loebsack (D-IA), would eliminate the current Condition of Payment requirement that physicians at Critical Access Hospitals certify, at the time of admission, that Medicare and Medicaid patients will not be at the facility for more than 96 hours. The legislation would not remove the requirement that CAHs maintain an average annual length of stay of 96 hours, nor affect other certification requirements for hospitals.
ICD-10 Compliance October 1, 2014
News Updates | February 6, 2014
ICD-10 in 2014
With less than one year to go until the October 1, 2014, ICD-10 compliance date, now is the time to assess your progress. CMS continues to work with health care organizations to develop and distribute a variety of resources to help you with your ICD-10 planning and preparation.
No matter where you are in your transition, there are ICD-10 resources available to you. Check the provider resources page on the CMS website frequently for news and information to help you prepare, and visit your professional organization’s website for resources tailored specifically to your needs.
Plan your journey – Look at the codes you use, prepare a budget, and build a team
Train your team – Many options and resources are available
Engage your partners – Talk to your software vendors, clearinghouses, and billing services
Test your systems and processes – Test within your practice and with your partners
2014 is the year of ICD-10. The ICD-10 transition will affect every part of your practice, from software upgrades, to patient registration and referrals, to clinical documentation and billing. With everyone in health care working toward a successful transition, now is the time to make sure you are ready too.
Keep Up to Date on ICD-10
Visit the CMS ICD-10 website for the latest news and resources to help you prepare for the October 1, 2014, compliance date. Sign up for CMS ICD-10 Industry Email Updates
ICD-10 in 2014
With less than one year to go until the October 1, 2014, ICD-10 compliance date, now is the time to assess your progress. CMS continues to work with health care organizations to develop and distribute a variety of resources to help you with your ICD-10 planning and preparation.
No matter where you are in your transition, there are ICD-10 resources available to you. Check the provider resources page on the CMS website frequently for news and information to help you prepare, and visit your professional organization’s website for resources tailored specifically to your needs.
Plan your journey – Look at the codes you use, prepare a budget, and build a team
Train your team – Many options and resources are available
Engage your partners – Talk to your software vendors, clearinghouses, and billing services
Test your systems and processes – Test within your practice and with your partners
2014 is the year of ICD-10. The ICD-10 transition will affect every part of your practice, from software upgrades, to patient registration and referrals, to clinical documentation and billing. With everyone in health care working toward a successful transition, now is the time to make sure you are ready too.
Keep Up to Date on ICD-10
Visit the CMS ICD-10 website for the latest news and resources to help you prepare for the October 1, 2014, compliance date. Sign up for CMS ICD-10 Industry Email Updates
Wednesday, February 5, 2014
Rural Metal Health & Substance Abuse Toolkit Webinar
Wednesday, February 26, 2014 12:00-1:00pm
Objectives of the webinar:
- · Identify evidence and promising models that improve access to mental health and substance abuse resources in rural communities.
- · Discuss setting specific models for communities, schools, and health care settings.
- · Describe lessons learned from effective mental health and substance abuse program planning, implementation, and evaluation.
How to Register –
Click Register.
On the registration form, enter your information and then click Submit.
Medicare News
JH Part B Webinar Handout: "Update - New Novitas Website" - February 13, 204 (1:00pm-2:30pm CT)
Join us as we demonstrate the improved Novitas Solutions website and show you how to navigate it. You will learn about the new available search tools as we provide tips to enhance your search results. You do not want to miss this!
JH Part B Claim Submission Errors
The Top Claim Submission Errors and their resolutions for December 2013 are now available. Take some time to review these errors and avoid them on future claim submissions.
Medicare Learning Network Matters Articles from CMS
New:
MM8545 – Inter-Jurisdictional Reassignments
MM8565 – 2014 Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) Healthcare Common Procedure Coding System (HCPCS) Code Jurisdiction List
SE1407 – Psychiatry and Psychotherapy Services
CMS delays inpatient, outpatient quality reporting deadlines
The Centers for Medicare & Medicaid Services Friday delayed to
Feb. 8 the deadline for reporting certain third-quarter 2013 quality data to
the Medicare inpatient and outpatient quality reporting programs. The one-week
delay affects inpatient population and sampling data for chart-abstracted
quality measures, outpatient population and sampling data, and outpatient
chart-abstracted measures. The delay was prompted by severe weather in the
Southeast, but applies to all hospitals participating in the programs.
Hospitals
with questions about the delay should contact their state Quality Improvement
Organization for more information. Other questions about the quality programs
should be directed to the QualityNet help desk at (866) 288-8912.
Tuesday, February 4, 2014
Medicare News
Expanding Customer Service Hours - February 3, 2014
In response to the high wait time to speak with a Customer Service Representative, we are expanding our hours of operation to better serve you. Effective February 3, 2014, our lines will open one hour earlier at 7:00 am CT. Please accept our apologies and be assured that we are working diligently to resolve this issue. We appreciate your patience.
Presidents’ Day Holiday Customer Service Units and EDI Availability
Novitas Solutions, Inc. will be observing the Presidents’ Day holiday on Monday, February 17, 2014.
Part B Top Inquiries FAQs
JH Part B Top Inquiries Frequently Asked Questions (FAQs)
The JH Part B Top Inquiries Frequently Asked Questions (FAQs) have been updated. Please visit our FAQs for the answers to your questions.
The JH Part B Top Inquiries Frequently Asked Questions (FAQs) have been updated. Please visit our FAQs for the answers to your questions.
The Established Patient: Billing and Coding Office Visits
JH Part B Webinar Handout: The Established Patient: Billing and Coding Office Visits-February 11, 2014 (1:00pm-2:00pm CT)
Join us for this fantastic webinar as we review the New versus Established Patient Rules, discuss the “Incident To” Criteria and provide answers to your Frequently Asked Questions. If you are new to Medicare billing and/or have a difficult time distinguishing between new or established patient, then this webinar is for you! Register today!
Join us for this fantastic webinar as we review the New versus Established Patient Rules, discuss the “Incident To” Criteria and provide answers to your Frequently Asked Questions. If you are new to Medicare billing and/or have a difficult time distinguishing between new or established patient, then this webinar is for you! Register today!
Evaluation and Management Score Sheet #2
Upcoming Events
JH Part B Webinar Handout: "Evaluation and Management Score Sheet Part 2- Introduction to the Score Sheet"-February 12, 2014 (1:00pm-2:00pm CT)
Join us for "Part Two-Understanding the Score Sheet" of the new series on Evaluation and Management Services. This four part series was developed to increase your understanding of evaluation and management services. The complete series will be presented every month with one part each week. It is recommended to take the entire series in order to maximize your understanding. However, if you miss any part of the series, it will be presented again the following month in the same order.
The series will consist of the following:
•Week One-Part One- Understanding the Key components of Evaluation and Management.
•Week Two-Part Two- Introduction to the Score Sheet,
•Week Three- Part Three- Using the Score Sheet
•Week Four- Part Four- Scoring Medical Records Using the Score Sheet.
If you are new to documenting and/or scoring evaluation and management services, this webinar event is for you. You must attend this event. Don't miss it, register today!
JH Part B Webinar Handout: "Evaluation and Management Score Sheet Part 2- Introduction to the Score Sheet"-February 12, 2014 (1:00pm-2:00pm CT)
Join us for "Part Two-Understanding the Score Sheet" of the new series on Evaluation and Management Services. This four part series was developed to increase your understanding of evaluation and management services. The complete series will be presented every month with one part each week. It is recommended to take the entire series in order to maximize your understanding. However, if you miss any part of the series, it will be presented again the following month in the same order.
The series will consist of the following:
•Week One-Part One- Understanding the Key components of Evaluation and Management.
•Week Two-Part Two- Introduction to the Score Sheet,
•Week Three- Part Three- Using the Score Sheet
•Week Four- Part Four- Scoring Medical Records Using the Score Sheet.
If you are new to documenting and/or scoring evaluation and management services, this webinar event is for you. You must attend this event. Don't miss it, register today!
QHi Back to Basics 02.26.14
The following event has been added to PiHQ: Partners in Healthcare Quality:
Event: QHi Back to Basics 022614
Location: Webinar/Conference Call
Starts At: Feb. 26, 2014 2:00 PM Central Time
Ends At: Feb. 26, 2014 3:00 PM
Information: All QHi participants are invited to join our next QHi Back to Basics Session scheduled for Wednesday, February 26 at 2:00 PM Central Time. We will walk through the live site demonstrating the basics of using the on line tool including measure selection, data submission and explore the many reporting opportunities available in QHi. A Q and A will follow, so bring questions for peers. Please go to https://cc.readytalk.com/r/ffgfoms9lflr&eom to register for the free webinar.
Monday, February 3, 2014
Delayed implementation of the 2 midnight Benchmark Policy
CMS announced that it would delay its full implementation of the 2 midnight Benchmark policy from March 31, 2014 to September 30, 2014. CMS will continue its partial-enforcement but it means during this period Recovery Auditors and other Medicare review contractors will not conduct post-payment patient status reviews of inpatient hospital claims with dates of admission on or after October 1, 2013 through October 1, 2014. CMS will still conduct its educational efforts on this policy.
Hospital Inpatient Admission Order and Certifications
CMS issued further guidance yesterday on Hospital Inpatient Admission Order and Certifications. Particularly, CMS clarified certain aspects of the 96 Hour certification requirement for Critical Access Hospitals (CAH). Of particular interest, CMS stated in this guidance:
If a physician certifies in good faith that an individual may reasonably be expected to be discharged or transferred to a hospital within 96 hours after admission to the CAH and something unforeseen occurs that causes the individual to stay longer at the CAH, there
would not be a problem with regards to the CAH designation as long as that individual's stay does not cause the CAH to exceed its 96-hour annual average condition of participation requirement. However, if a physician cannot in good faith certify that an individual may reasonably be expected to be discharged or transferred within 96 hours after admission to the CAH, the CAH will not receive Medicare reimbursement for any portion of that individual's inpatient stay.
This answers the question as to what happens with stays that exceed 96 hours that are unexpected. However, this guidance does nothing to help CAH's that have developed service lines that treat higher acuity patients and places these facilities at risk for the cost of the entire hospital stay per the last sentence.
If a physician certifies in good faith that an individual may reasonably be expected to be discharged or transferred to a hospital within 96 hours after admission to the CAH and something unforeseen occurs that causes the individual to stay longer at the CAH, there
would not be a problem with regards to the CAH designation as long as that individual's stay does not cause the CAH to exceed its 96-hour annual average condition of participation requirement. However, if a physician cannot in good faith certify that an individual may reasonably be expected to be discharged or transferred within 96 hours after admission to the CAH, the CAH will not receive Medicare reimbursement for any portion of that individual's inpatient stay.
This answers the question as to what happens with stays that exceed 96 hours that are unexpected. However, this guidance does nothing to help CAH's that have developed service lines that treat higher acuity patients and places these facilities at risk for the cost of the entire hospital stay per the last sentence.
CMS Open Door Forum
As a reminder, CMS is hosting a follow-up Open Door Forum (ODF) call on Tuesday, Feb. 4, 2014 at 1:00 pm to 2:00 pm ET. This will be a follow-up call to allow hospitals, practitioners and others to ask questions on the physician order and physician certification, 2 midnight benchmark for inpatient hospital admissions and medical review criteria that were released in Aug., 2013 and January 31, 2014.
This is a conference call only. If you wish to participate, dial: (877) 251-0301 & Conference ID: 47736519.
This is a conference call only. If you wish to participate, dial: (877) 251-0301 & Conference ID: 47736519.
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