Undercoding Is it Worth it?
What is the issue?Hospitals are undercoding the services and items furnished to beneficiaries in a continual effort to avoid federal audits.…
Clarifications to CMS’ Longstanding Three-day Rule
The Centers for Medicare & Medicaid Services’ (CMS’) three‐day rule, also known as the 72‐hour rule, has remained unchanged since its…
Advance Beneficiary Notice Form: CMS Announces New ABN Modifiers
In 2009, the Centers for Medicare & Medicaid Services (CMS) implemented the use of the revised Advance Beneficiary Notice Form…
Surgical Never Events Billing Related and Non-related Services
Surgical “Never Events” Billing Related and Non-related Services As a follow-up to last month’s Current Developments’ article titled “Reporting E-codes for Surgical…
Protect Yourself: Know How to Bill Medicare for H1N1 and Seasonal Flu Vaccines to Prevent Revenue Loss
According to the Centers for Disease Control and Prevention (CDC), there have been 22,364 laboratory confirmed hospitalizations and 877 laboratory‐confirmed deaths…
Starting October 1, 2009 Providers Must Report E-codes for Surgical Never Events
Effective October 1, 2009, the Centers for Medicare & Medicaid Services (CMS) will require all providers to submit E codes for…
Incident-to Supervision of Outpatient Therapeutic Services: Are You in Compliance?
IntroductionOn April 14, 2009, 12 health care organizations submitted a letter to the Centers for Medicare & Medicaid Services (CMS) requesting…
CMS’ Anti-markup Rule
The Centers for Medicare & Medicaid Services (CMS) recently issued Transmittal 445 to provide claims processing instructions for contractors when submitting…
Durable Medical Equipment (DME) Documentation Required for Medicare Payment
Recent Developments Highlight the Importance of Medical Necessity Documentation The U.S. Supreme Court recently denied review in a case, reaffirming the…
A Refresher: Observation Services
When tracking patients’ admissions status, identifying services rendered, calculating the number of observation hours, and ensuring accuracy and completeness of medical…
Figuring out the Codes: Inpatient Rehabilitation Facilities and the Transfer Policy
Inpatient rehabilitation facilities (IRFs) are hospitals (or subunits of a hospital) that offer intensive rehabilitation services to the inpatient population. The…