NEWS YOU CAN USE: Name Your Patient's Renal Disease Correctly With 4th Digit

· A three-digit kidney disease diagnosis code may buy you a speedy denial

Warning: Your Medicare fiscal intermediary (FI) won’t pay for claims unless you identify the stage of your patient’s kidney disease. For dates of service (DOS) on or after Oct. 1, 2005, CMS will no longer accept code 585 (Chronic kidney disease) without the fourth digit extension that further specifies the diagnosis, the agency announced in an Oct. 26 Medlearn Matters article.
 
Instead, you should report one of the following applicable diagnosis codes: 585.1 (Chronic kidney disease, Stage I); 585.2 (...Stage II [mild]); 585.3 (...Stage III [moderate]); 585.4 (...Stage IV [severe]); 585.5 (...Stage V); 585.9 (...unspecified); or 585.6 (End stage renal disease).
To read the Medlearn Matters article, go to http://www.cms.hhs.gov/medlearn/matters/mmarticles/2005/MM4108.pdf.

· Got a new provider number? Expect changes to your CCR

If your hospital merges with another hospital, your Medicare fiscal intermediary (FI) will continue to use the operating and capital cost-to-charge ratio (CCR) from the hospital with the “surviving” provider number.

On the other hand: If Medicare issues the hospitals a new provider number following a merger, the FI will use the statewide average CCR because “a new provider number indicates the creation of a new hospital,” CMS says in an Oct. 13 Medlearn Matters article. You can request that your FI use a higher or lower CCR--but you must provide substantial evidence to support your request, CMS notes.
CMS has issued a new Nov. 7 effective date for its changes in FI’s CCR-calculation methods. For more information, go to http://www.cms.hhs.gov/medlearn/matters/mmarticles/2005/MM3966.pdf.

· States’ overstated UPL payment amounts may hurt your hospital’s bottom line

If your state includes unpaid Medicaid claims in its upper payment limit (UPL) calculations for your hospital, the Office of the Inspector General (OIG) could force your state to ask you to return the extra payments.

The OIG asked the Indiana Medicaid program to refund more than $3 million of its UPL payments from state fiscal years (SFYs) 2001 and 2002 in an Oct. 18 audit report. For SFY 2001, Indiana overstated the amounts available for UPL payments to non-state government hospitals by $2.2 million, the OIG claims. The state also overstated amounts for SFY 2002 by approximately $4.3 million, according to the report.
The state’s UPL calculations included unpaid claims rather than Medicaid payments, which conflicted with its plan provisions. Indiana also allegedly used an incorrect Medicare cost-to-charge ratio, which led to an understatement for one hospital and overstated its hospital graduate medical education expenses, the OIG says.
 
Indiana disagreed with the OIG’s recommendations to refund the Medicaid UPL payments’ [...]

- Published on 2005-11-21