1.800.456.4350 info@prgweb.com

Archive for March, 2014

The New CMS-1500 Form Version 02-12 Becomes Mandatory

Monday, March 31st, 2014

On April 1, the new CMS-1500 Claim Form (02-12) became mandatory. The new version includes changes for diagnosis coding and qualifiers which identify ordering, referring or supervising provider roles.

For more facts and information about the new CMS-1500 Claim Form (02-12), please visit the Web site at CMS-1500 Claim Form Completion Instructions

FDA Releases Report on Medical Device Recalls

Monday, March 24th, 2014

According to a new report from the Food & Drug Administration’s (FDA) Center for Devices and Radiological Health (CDRH), the annual number of medical device recalls increased by 97% between fiscal years 2003 and 2012, to 1,190. The most frequent causes for recalls are related to device design, software, and non-conforming material or component issues. The number of Class I recalls went from 7 in FY 2003 to 57 in FY 2012, while Class II recalls rose from 460 to 1,043. The report states that the increase is due to a greater focus and attention on improving product quality in certain areas, including radiology devices, ventilators, infusion pumps and external defibrillators.

The report can be viewed at http://www.fda.gov/downloads/AboutFDA/CentersOffices/OfficeofMedicalProductsandTobacco/CDRH/CDRHTransparency/UCM388442.pdf.

Update to the Two-midnight Guidance Issued

Thursday, March 13th, 2014

CMS plans to issue guidance to Medicare Administrative Contractors (MACs), Medicare Recovery Auditors (RACs), and other review contractors. This update will provide further guidance for the determination of the appropriateness of inpatient hospital admission.  CMS will instruct Medicare review contractors to assess the hospital’s compliance with three things – the admissions order requirements, the certification requirements, and he two-midnight benchmark.

For further details, the updated guidance can be viewed at http://cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Medical-Review/Downloads/ReviewingHospitalClaimsforAdmissionforPosting03122014.pdf.

HHS Releases Health Plan Standards Final Rule

Friday, March 7th, 2014

The Centers for Medicare & Medicaid Services (CMS) has issued a final rule regarding certain payment parameters and standards for health insurers and the Health Insurance Marketplace for the 2015 benefit year. Based on a fact sheet released by CMS, the provisions pertain to premium stabilization programs, the open enrollment period for 2015, annual limitations on cost sharing, consumer protections, financial oversight, and the Small Business Health Options Program (SHOP). According to the final rule, the open enrollment period for the 2015 benefit year will begin on November 15, 2014 and extend through February 15, 2015.

The final rule can be viewed at http://www.ofr.gov/OFRUpload/OFRData/2014-05052_PI.pdf.

The CMS fact sheet can be found at http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2014-Fact-sheets-items/2014-03-05-2.html?DLPage=1&DLSort=0&DLSortDir=descending