Have You Heard? - February 2, 2012
13 Top Management Challenges and Issues for HHS

• Have you ever wondered what's on the minds of the folks at Health and Human Services (HHS)? The Office of the Inspector General (OIG) has released its annual report of the "top management and performance challenges" facing the Department of HHS. Read more about the 13 areas they identify at the OIG site:
  - OIG Report on Top Issues for HHS

Have You Heard? - January 24, 2012
OIG Medicare Fraud Training for New Physicians

• The HHS/OIG website has some free training material, including a booklet, Powerpoint presentation, and speaker notes, for new physicians. The topic is "Avoiding Medicare and Medicaid Fraud and Abuse -- A Roadmap for New Physicians". Check it out on the OIG website:
  - Fraud Training for New Physicians

Have You Heard? - January 12, 2012
OIG Training on Provider Compliance

• On the website for the HHS Office of Inspector General (OIG), you can access free training (videos and audio podcasts) on provider compliance from the Health Care Fraud Prevention and Enforcement Action Team (HEAT):
  - HEAT Training on Provider Compliance

Have You Heard? - December 7, 2011
OIG Work Plan for 2012

• It's out, and ready for your examination and discussion. The Office of Inspector General (OIG) has released its OIG Work Plan for FY 2012, covering the activities it plans to initiate or continue. Some of these might have an impact from a coding perspective. Download the report from their website:
  - 2012 OIG Work Plan from OIG website

Have You Heard? - November 30, 2011
CMS Overview of Physician Fee Schedule for CY 2012

• In case you haven't seen it, here's the link to the overview page on the CMS website, with information on the Physician Fee Schedule changes in store for the calendar year 2012.
  - Physician Fee Schedule for CY 2012 on CMS website

Have You Heard? - November 7, 2011
ICD-10 Conference Call from CMS/AHA/AHIMA/CDC

• On Thursday, November 17, the Centers for Medicare & Medicaid Services (CMS) and American Hospital Association (AHA) will host a conference call on ICD-10 topics. Scheduled speakers are from CMS, AHA, American Health Information Management Association (AHIMA), and the Centers for Disease Control (CDC). You might be able to earn AAPC CEUs for attending this telephone conference call, but see the AHA page for details.
  - ICD-10 call registration and info on the AHA website

Have You Heard? - October 18, 2011
ICD-10 Teleseminar Notes from CMS

• At the end of April 2011, CMS and AAPC collaborated on a "Code-a-thon" teleseminar about the upcoming ICD-10 changes. In case you missed it then, the Powerpoint slides from the CMS and AAPC presenters, and the transcript are available for download from the CMS website. The links below take you to these downloads.
  - CMS Code-a-thon Powerpoint slides
  - AAPC Code-a-thon Powerpoint slides
  - Audio transcript for the Code-a-thon

Have You Heard? - October 11, 2011
Flu Vaccine Finder from HHS

• It's that time of the year again! The U.S. Department of Health and Human Services (HHS) has a convenient flu vaccine locator. Just go to www.flu.gov, enter your zip code, and you'll get a list of flu vaccine providers near you.
  - Flu Vaccine Finder from the HHS

Have You Heard? - October 5, 2011
October is National Breast Cancer Awareness Month

• Secretary of Health and Human Services (HHS) Kathleen Sibelius has released a statement reaffirming their commitment to fighting the disease, and reminding about the importance of prevention and early detection.
  - HHS Secretary Sibelius's statement

Have You Heard? - September 26, 2011
Spotlight on Independent Diagnostic Testing Facilities (IDTFs)

• The Office of Inspector General's (OIG) latest investigation focused on independent diagnostic testing facilities (IDTFs), in this case, located in the Los Angeles and Miami areas. Many Medicare dollars over the years have been paid out to facilities that were either closed or non-existent. Check out the OIG report to see how they went about their investigation, and what their findings were.
  - OIG spotlight on IDTFs

Have You Heard? - September 14, 2011
Spotlight on Power Wheelchairs

• Office of Inspector General recently completed a study of the billing of power wheelchairs to Medicare. In the first half of 2007 alone, $95 million dollars, or 61 percent of all claims for power wheelchairs, were deemed medically unnecessary or had insufficient documentation. The link takes you to the OIG site for their findings and recommendations.
  - OIG spotlight on power wheelchair fraud

Have You Heard? - August 30, 2011
Colleges Where OIG/HHS Recruits Future Auditors

• Ever wonder where the Office of Inspector General (OIG) at HHS recruits their auditors who work in the Office of Audit Services (OAS)? Check out their list of colleges that they recruit from. The greatest number of colleges are in California, followed by New York and Washington state.
  - Colleges where OIS/OAS recruits

Have You Heard? - August 11, 2011
Preventive Services for Women at No Additional Cost

• In case you missed it last week, the U.S. Department of HHS released an announcement that the Affordable Care Act will ensure that women receive preventive health care services at no additional cost. Follow the link to the release on the HHS site and more details.
  - HHS on Preventive Services for Women

Have You Heard? - July 28, 2011
LTCH Payments for Interrupted Stays
Medicare Foot Care Coverage

• Need a refresher on what to do about Long Term Care Hospital (LTCH) payments when there is an "interrupted stay"? A Fact Sheet from CMS addresses questions on this situation.
  - Fact Sheet: LTCH Payments for Interrupted Stays
   
• Want a summary of Medicare's foot care coverage? An article from CMS's MLN Matters will give you the guidelines:
  - Medicare foot care coverage guidelines

Have You Heard? - July 19, 2011
Correct Billing of Inpatient Admission Date
Medicare Billing by Speech-Language Pathologists

• CMS has posted an article “Correct Provider Billing of Admission Date and Statement Covers Period”. This article defines and discusses reporting inpatient hospital admission day with the "from" and "through" dates associated with an inpatient hospital stay. This will apply to claims submitted on or after October 1, 2011 and for providers who report their services on the UB-04. Click on the link below to read more.
  - CMS article on billing of admission date
   
• Just recently released, a Medicare "fact sheet" on billing for services by speech-language pathologists in private practice. Click to read more:
  - Medicare fact sheet re speech-language pathologists

Have You Heard? - July 12, 2011
OIG Report on Changes in Skilled Nursing Facility Billing
Coming in 2014: Affordable Insurance Exchanges

• The Office of Inspector General (OIG) just released a report on changes Skilled Nursing Facilities (SNF) billing. Changes made to this type of billing resulted in an increase in payments instead of being budget neutral. The OIG will be making recommendations to address this:
  - OIG report on SNF billing changes
   
• Just announced yesterday, HHS and state governments are moving to implement in 2014 "affordable insurance exchanges", which would enable individuals and small businesses to shop for and purchase healthcare coverage in new competitive marketplaces. More info on the HHS website:
  - HHS info on Affordable Insurance Exchanges

Have You Heard? - June 29, 2011
Medicare Coverage Abroad
Telehealth Services Guide

• Ever wonder what coverage Medicare beneficiaries get while they're traveling abroad, or on a cruise ship? Here's a CMS fact sheet with the overview:
  - Facts on Medicare coverage outside the U.S.
   
• In rural or more remote areas, health services might be provided using telecommunications methods. CMS has a fact sheet on the so-called "Telehealth Services":
  - Telehealth Services fact sheet from CMS

Have You Heard? - June 22, 2011
2012 Official ICD-10-PCS Coding Guidelines
Medicare Annual Wellness Visit

• The 2012 Official ICD-10-PCS Coding Guidelines are available for download through the CMS/Medicare website:
  - 2012 Official ICD-10-PCS Coding guidelines
   
• Under the Affordable Health Care Act, Medicare beneficiaries recently became eligible for a covered annual wellness visit (AWV). During the AWV, health care providers will review the patient’s history and risk factors for diseases and other evaluation services. Click on the link for a Quick Reference Guide from the CMS website:
  - AWV Quick Reference Guide

Have You Heard? - June 9, 2011
Medicare Enrollment Guidelines for Referring Providers
Updates to Long Term Care Hospital (LTCH) PPS

• Questions about the Medicare enrollment guidelines for ordering and/or referring providers? Check out this fact sheet from CMS's Medicare Learning Network.
  - Medicare provider enrollment fact sheet
   
• The Long Term Care Hospital Prospective Payment System updates appeared in March 2011. In case you haven't seen them, here's the fact sheet from CMS:
  - LTCH PPS latest update March 2011

Have You Heard? - May 20, 2011
ICD-10 National Provider Teleconference Slides

• On Wednesday, May 18, a national provider teleconference was held on ICD-10, entitled "CMS ICD-10 Conversion Activities National Provider Teleconference - Including a Lab Case Study". The Powerpoint slides from that presentation are now available from the CMS website. No speaker notes, but some of the slides are detailed enough to offer insight into some of the processes.
  - Slides for CMS ICD-10 teleconference

Have You Heard? - May 11, 2011
OIG's "10 Most Wanted Fugitive" List

• The Office of Inspector General (OIG) actually has a "10 Most Wanted Fugitive" list of people they're seeking on charges of healthcare fraud and abuse. Scroll through the list and check it out -- if you see anyone you recognize, be sure to contact OIG!
  - OIG 10 Most Wanted List
   
• This week is National Women's Health Week. In case you're interested in more information, here's the link to the HHS-sponsored website.

Have You Heard? - May 5, 2011
OIG Booklet on Avoiding Medicare/Medicaid Fraud

• The Office of Inspector General (OIG) developed a document that summarizes the five main Federal healthcare fraud and abuse laws, and provides tips on how physicians should comply with these laws. Subjects covered include the physician's relationship with payers, other providers, and with vendors, and how these laws affect medical coding and documentation.
  - Avoiding Medicare and Medicaid Fraud and Abuse

Have You Heard? - April 27, 2011
Fact Sheet on Physician Signature Requirements

• A fact sheet from CMS describing common Comprehensive Error Rate Testing (CERT) Program error related to provider signature requirements.
  - Fact Sheet on Signature Requirements

Have You Heard? - April 7, 2011
Medicare Drug Screen Testing
Home Health PPS Fact Sheet

• Just updated in March by CMS and now available for download is the "Ambulance Fee Schedule Fact Sheet". This fact sheet provides information on the Ambulance Fee Schedule, including background, ambulance providers and suppliers, ambulance services payments, and how payment rates are set. Click on the link to access the fact sheet.
  - Ambulance Fee Schedule Fact Sheet
   
• Also from CMS and The Medicare Learning Network, "The ABCs of Providing the Initial Preventive Physical Examination" Quick Reference guide is available to Medicare Fee-For-Service providers. This provides a list of the elements of the IPPE, as well as coverage and coding information. Click the link below to view and print this resource.
  - IPPE Quick Reference Guide

Have You Heard? - March 22, 2011
Medicare Drug Screen Testing
Home Health PPS Fact Sheet

• Read about how clinical diagnostic labs should bill for certain types of tests covered under Medicare. Click on the link to read the article:
  - Medicare Drug Screen Testing article from MLN
   
• The updated Home Health PPS Fact Sheet (revised January 2011) includes information and consolidated billing requirements, coverage of HHS services, and other aspects and requirements of Home Health PPS. Click and read more:
  - Medicare Home Health PPS Fact Sheet

Have You Heard? - March 17, 2011
Myths About Seasonal Allergies

• While a lot of us are eager for the end of winter, that usually signifies the start of the spring allergy season. Are you aware of some of the common myths regarding allergies?
  - Combating Myths About Allergies

Have You Heard? - March 9, 2011
Medicare Appeals Process
ICD-10 Updates and Teleconferences

• Learn more about the Medicare appeals process through “The Medicare Appeals Process: Five Levels to Protect Providers, Physicians and Other Suppliers”. This publication provides an overview of the 5 levels of the Medicare appeals process, for physicians, providers, and other suppliers who provide services/supplies to Medicare patients. Click the link below to learn more about this process.
  - Medicare Appeals Process info sheet
   
• Some updates from CMS regarding ICD-10 implementation and upcoming teleconferences. Keep up on what’s happening with ICD-10 with these two CMS sponsored sites.
  - ICD-10 Overview/Updates site
  - ICD-10 Teleconferences

Have You Heard? - February 15, 2011
Medicare E/M Service Guide
Immunization Billing Quick Reference Guide

• The Evaluation and Management Service Guide is now available from Medicare. This guide is designed to provide general overview on E/M guidelines, documentation, and coding. (This is not a substitute or replacement of the 1995 and 1997 guidelines.) Click the link below to view the guide.
  - Medicare E/M Service Guide
   
• The Medicare Immunization Billing quick reference guide provides Medicare Fee-For-Service physicians, providers, suppliers, and other healthcare professionals with quick information to help with filing claims for influenza vaccine, pneumococcal vaccine, and Hepatitis V Virus (HBV) vaccine and their administration. Click on the link below to view this reference guide.
  - Immunization Billing Quick Reference Guide

Have You Heard? - February 2, 2011
New HHS Rules
Medicare Releases ASC Fee Schedule

• HHS has introduced new rules and tools to focus more proactively on fraud prevention by stopping criminals from getting into the system in the first place. More details in a fact sheet on the HealthCare.gov site.
  - New Anti-Fraud HHS Rules
   
• Medicare has released the latest fee schedule for Ambulatory Surgical Centers (ASCs). Details on its fact sheet from the Medicare Learning Network.
  - Latest ASC Fee Schedule

Have You Heard? - January 26, 2011
Doctors Exempt from Red Flags Rule

• Last month, President Obama signed into law legislation that clarified the term "creditor" in the Red Flags Rule. Physicians and other small businesses are now exempt from implementing the regulation. But don't let that stop you from taking the precautions mentioned by the Rule -- it's just good business to safeguard your practice from medical identity theft.
  - Doctors Exempt from Red Flags Rule

Have You Heard? - December 20, 2010
Maximum Period to Submit Medicare Claims Not More Than 12 Months

• With year-end approaching, CMS wants to remind all fee-for-service physician, providers and suppliers about submitting claims to Medicare for payment due to the Patient Protection and Affordable Care Act (PPACA). Services provided on or after January 1, 2010 must be submitted to your Medicare contractor not later than one calendar year (12 months) from the date of service or Medicare will deny the claim. Click on the links below for more information.
  - Claims Submission Guidelines and Limits
  - Additional Instructions for Timely Claims Filing

Have You Heard? - November 19, 2010
Inpatient Rehabilitation Facility PPS Fact Sheet
Medicare Qualifications/Billing Handbook for APNs and PAs

• Here's a fact sheet including payment rates, classification and other criteria for inpatient rehabilitation facilities, from CMS:
  - Inpatient Rehab Facility PPS fact sheet
   
• This publication from CMS has information on coverage criteria, qualifications, billing, and payment for Medicare services provided by Advanced Practical Nurses and Physician Assistants:
  - Medicare Information for APNs and PAs

Have You Heard? - October 13, 2010
Medicare's Coverage of the Influenza Vaccine
Information Booklet on ABN

• With flu season approaching again, you might want to review Medicare’s coverage of the influenza vaccine and its administration, on the CMS website:
  - Medicare coverage of the flu vaccine
   
• Does your practice work with Advance Beneficiary Notice of Noncoverage (ABN)? Here's a booklet from the Medicare Learning Network that serves as a good review of the topic:
  - ABN Part A and Part B Overview

Have You Heard? - October 6, 2010
Medicare Secondary Payer Fact Sheet
Outpatient PPS PC Pricer Q4 Release

• Medicare Secondary Payer fact sheet now available through the Medicare Learning Network. See it here:
  - Medicare Secondary Payer fact sheet
   
• Looking for the 4th Quarter 2010 release of the data for the Outpatient PPS PC Pricer, which is used to estimate Medicare PPS payments? Here is the information page, which says the download "files contain the logic, rates, wage index, and off-set amounts used by the OPPS PRICER program to calculate APC rates, coinsurance and deductibles".
  - Outpatient PPS Pricer info

Have You Heard? - September 1, 2010
Additional Information for Timely Claims Filing
How to Use NCCI Tools

• Additional information has been issued by CMS regarding timely filing of claims, to be effective on January 1, 2011:
  - CMS info on timely filing of claims
   
• According to CMS, the National Correct Coding Initiative (NCCI) "was implemented to promote correct coding methodologies and to control improper coding leading to inappropriate payment." Read more in their "How To" booklet:
  - NCCI How To Booklet

Have You Heard? - August 18, 2010
Medical Records Retention Guidelines
Fact Sheets on 5010/ICD-10 Transitions

• Recently-issued guidelines on "Medical Records Retention and Media Formats"; click on the link:
  - Medical records retention guidelines
   
• A couple of CMS quick-reference fact sheets on the upcoming 5010/ICD-10 transition:
  - ICD-10 Transition: An Introduction
  - Tips for Medical Practices re ICD-10 and Version 5010

Have You Heard? - August 11, 2010
Medicare Learning Network Courses
WHO Declares End of 2009 H1N1 Pandemic

• The Medicare Learning Network is now offering web-based training courses on coding and billing for Medicare coverage of preventive services. Here are just a few of the topics covered:
  
  - Initial preventive physical exam
  - Diabetes screening tests
  - Supplies and other services for beneficiaries with diabetes
  - Ultrasound screening for abdominal aortic aneurysms (AAA)
  
  Click on the link below to see the full listing of courses.
  - Medicare Learning Network courses
   
• The World Health Organization yesterday declared the end of the 2009 H1N1 influenza pandemic. Read the HHS press release:
  - WHO declares end of 2009 H1N1 pandemic

Have You Heard? - July 23, 2010
Red Flags Rule Deadline Delayed

• The deadline for implementation of the FTC's Red Flags Rule has been delayed from the previously scheduled June 1, 2010, to December 31, 2010, because of a lawsuit filed by the American Medical Association and two other groups. Read more:
  - Red Flags Rule deadline delayed

Have You Heard? - June 17, 2010
Medicare Claims Submission Period Reduced
Local Medicare EDI Help Line Numbers

• As of January 1, 2010, the submission period for Medicare claims was reduced to one year. Check out the information sheet from CMS (Adobe Acrobat Reader required):
  - CMS information on Medicare claims submission period
   
• Need help with or have questions on Medicare electronic data interchange (EDI)? Get the list, by state, of local help line phone numbers from CMS. Most are toll-free numbers, but a few are not. (Adobe Acrobat Reader required.)
  - List of Part A help lines
  - List of Part B help lines

Have You Heard? - June 11, 2010
ICD-10 Coding Guidelines Manual
New Electronic Transactions Standards

• Here's the link to the 98-page 2010 ICD-10 Official Coding Guidelines from CMS (Adobe Acrobat Reader required):
  http://www.cms.gov/ICD10/Downloads/7_Guidelines10cm2010.pdf
   
• The most current "fact sheet" from CMS regarding the upcoming transition to new electronic transactions standards for the following versions adopted by HHS: ASC X12 Version 5010, and NCPDP Versions D.0 and 3.0 (Adobe Acrobat Reader required).
  http://www.cms.gov/ICD10/downloads/w5010BasicsFctSht.pdf

Links to Associations and Organizations

• American Academy of Professional Coders (AAPC)
  http://www.aapc.com
   
• American Health Information Management Association (AHIMA)
  http://www.ahima.org
   
• Practice Management Institute (PMI)
  http://www.pmimd.com
   
• Centers for Medicare & Medicaid Services (CMS)
  http://www.cms.gov
   
• U.S. Department of Health and Human Services (HHS)
  http://www.hhs.gov