Medicare Compliance & Reimbursement
IN OTHER NEWS ...• Wondering how the new Recovery Audit Contractors plan to review -- and possibly deny -- your claims from afar?
Now you have part of the answer.The RAC for 17 states, Las Vegas-based HealthDataInsights Inc., will use Milliman Care Guidelines "content and software" to review Medicare claims, Milliman says in a release. "The Care Guidelines promote healthcare quality by providing clinical guidelines based on the best available clinical evidence," the Seattle-based company says. The company provides guidelines for seven topic areas including home care and chronic care. The Care Guidelines include quality measures and "each guideline topic outlines key issues, and provides details on clinical interventions to improve patient outcomes," Milliman says. • With the recovery audit contractor (RAC) program back in business as of last week, you can't miss a chance to ensure that you know all there is about RAC contractors and their habits. That's why a new CMS transmittal may be the most interesting reading material you've come across in a long while. CMS Transmittal 148, dated March 6, offers updated advice on communication with RACs, points of contact, and an overview of the entire RAC process. Plus: The transmittal offers some insight into the RAC exclusion program, noting, "The RAC can permanently exclude an individual claim or a series of claims, or suppress a provider's entire claim submission or claim type for a period of time not to exceed one calendar year," and offers a list of cases requiring suppression or exclusion. To read the transmittal, visit www.cms.hhs.gov/transmittals/downloads/R148FM.pdf. • Starting July 7, you should begin seeing your NPI on all paperwork from the National Supplier Clearinghouse. A Feb. 27 transmittal (CR 6314,Transmittal No. 451) from CMS instructs the NSC to "insert the NPI into all correspondence, including preprinted re-enrollment packages." The NSC will also validate all NPIs received from suppliers starting in July, says the transmittal. To read the CMS transmittal online, visit www.cms.hhs.gov/transmittals/downloads/R451OTN.pdf.
Medicare Compliance & Reimbursement
- COMPLIANCE:
Let The OIG Advisory Process Help Your Practice
Tip: Ask before you implement policies. You've most likely read one or two of the [...] - CORRECT CODING INITIATIVE:
CCI Institutes Over 300,000 New Code Pair Edits
This round, CCI also creates a few welcome deletions. If you thought CCI versions after [...] - BUNDLING:
3 Code Pairs You May Not Want To Report Together
Here's expert advice on reporting your code combinations correctly. The Correct Coding Initiative (CCI) offers [...] - OBSERVATION CODING:
Observation Stays Are on the Rise -- 4 Tips Help Code Them
Hint: Roll office visit, observation stay into one code. Physicians are admitting more patients than [...] - READER QUESTION:
Do You Know How to Report Hospital Discharge After Consultation?
Tip: Know which doc attended and which referred to ensure you report patient visits correctly [...] - PART B MYTHBUSTERS:
Just Because CCI Doesn't 'Bundle' Procedures Doesn't Mean You Can Always Bill Them Together
Even if CCI doesn't publish edits bundling two procedures together, your practice should know which [...] - CODING COACH:
Keep Scope Coding 'In The Family' To Avoid Errors
Are you missing out on hundreds? Now's the time to find out. Coding scope procedures, [...] - INDUSTRY NOTES:
CMS Corrects 2009 Physician Fee Schedule Final Rule
Plus: One RAC reveals information about how it will evaluate claims during its review process. [...] - IN OTHER NEWS ...• Wondering how the new Recovery Audit Contractors plan to review -- and possibly deny -- your claims from afar?
Now you have part of the answer.The RAC for 17 states, Las Vegas-based HealthDataInsights Inc., [...]
