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Archive for February, 2011

Status of State Medicaid RAC Programs Launched

Wednesday, February 23rd, 2011

The Centers for Medicare & Medicaid Services (CMS) has delayed the proposed April 1 deadline for states to implement their Medicaid RAC programs. CMS stated that the delay is in consideration of state operational issues and will help ensure that states comply with the provisions of the final rule. CMS expects to issue a new implementation deadline when it publishes the final later this year.

In addition, CMS has released a map that summarizes the status of each state’s RAC program based on information submitted in the Medicaid State Plan amendment.

The website for the Medicaid RACs is at http://www.cms.gov/medicaidracs/home.aspx.

Reprocessing Retroactive Adjustments Begins

Tuesday, February 22nd, 2011

The Centers for Medicare & Medicaid Services (CMS) will begin reprocessing Medicare claims affected by retroactive provisions of the Patient Protection and Affordable Care Act (ACA) and physician fee schedule legislation. These include claims for physicians, hospitals and other care providers affected by payment adjustments retroactive to October 1, 2009, January 1, 2010 and April 1, 2010. CMS believes that reprocessing will start with inpatient claims followed by outpatient claims and then physician claims. The Medicare claims administration contractor will automatically reprocess a provider’s retroactive adjustments. However, providers will need to request a manual reopening/adjustment from their Medicare contractor for any claims with submitted charges lower than the revised 2010 physician fee schedule amount.

For more information, see the CMS notice at https://list.nih.gov/cgi-bin/wa.exe?A2=ind1102&L=PHYSICIANS-L&O=D&P=2690.

Draft ICD-10 Definitions Manual Published

Wednesday, February 16th, 2011

The Centers for Medicare & Medicaid Services (CMS) has issued a draft ICD-10 definitions for the Medicare Severity-Diagnosis Related Groups (MS-DRGs) for fiscal year 2011. The draft also includes abbreviated titles for the ICD-10-CM and ICD-10-PCS code descriptions. The draft definitions, which are subject to formal rulemaking, were developed by the ICD-10 MS-DRG Conversion Project and will allow providers to understand the impact of ICD-10 on their MS-DRG payments

More information can be obtained at http://www.cms.gov/ICD10/11b1_2011_ICD10CM_and_GEMs.asp

RAC Record Request Limits Announced by CMS

Monday, February 14th, 2011

The Centers for Medicare & Medicaid Services (CMS) has announced new limits on the number of medical records that Recovery Audit Contractors (RAC) may request when reviewing Medicare claims by physicians and other practitioners. The policy allows RACs to begin complex review of claims for physicians and non-physician practitioners. RACs use the records to validate billing practices and medical necessity for services provided to Medicare patients. The guidelines limit record requests within a 45-day period based on the provider’s Medicare claims for the previous calendar year.

For details, see the CMS notice at http://www.cms.gov/RAC/Downloads/PhyADR.pdf.

HHS Announces ACA Prevention Funding

Wednesday, February 9th, 2011

The Department of Health and Human Services (HHS) has announced $750 million in fiscal year 2011 investments from the Patient Prevention and Affordable Care Act’s (ACA) prevention fund. Building on $500 million in investments last year, HHS said the new funds will help prevent tobacco use, obesity, heart disease, stroke and cancer; increase immunizations; and empower individuals and communities with tools and resources for local prevention and health initiatives.

More information can be viewed at http://www.hhs.gov/news/press/2011pres/02/20110209b.html

New EHR Incentive Program Listserv Available

Friday, February 4th, 2011

The Centers for Medicare & Medicaid Services (CMS) has a new listserv about the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. The listserv will provide timely, authoritative information about the programs, including registration and attestation updates, and details about the payment process.

 Information for joining the listserv is available at http://www.cms.gov/EHRIncentivePrograms/65_CMS_EHR_Listserv.asp#TopOfPage

Revised Hospital Inpatient PPS Fact Sheet Available

Thursday, February 3rd, 2011

The revised fact sheet titled Acute Care Hospital Inpatient Prospective Payment System, which provides information about the basis for Acute Care Hospital Inpatient Prospective Payment System (HIPPS) payment, payment rates, and how payment rates are set is available from the Medicare Learning Network®.  

For more information, visit http://www.cms.gov/MLNGenInfo