Medicare Compliance & Reimbursement

As promised, the Centers for Medicare & Medicaid Services (CMS) has finally revealed the dates of its latest ICD-10 testing opportunities. MLN Matters article MM8858, issued on Aug. 22, outlines the following date ranges when you can test out your ICD-10 claims:

• Nov. 17 to 21, 2014
• March 2 to 6, 2015
• June 1 to 5, 2015

During these periods, trading partners will have access to MACs and CEDI for testing “with real-time help desk support,” the article says. You’ll submit your claim with actual, current dates of service since the testing will kick out claims that feature dates in the future. All claims will be subject to NPI validation edits, and you’ll get a response message acknowledging whether Medicare rejected or accepted your sample claims.

Resource: To read more about the testing opportunities, visit www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8858.pdf. 

CMS Launches New ICD-10 Training Webcast Series

Your coders are well-versed in the nuances of ICD-10, but physicians are flummoxed about what the transition will mean for their documentation — and that’s where CMS steps in. The agency has launched an “ICD-10 Documentation and Coding Concepts” series that aims to help providers learn how to document for the new diagnosis coding system that will go into effect in 2015.

The five webinars are presented by physicians from varying specialties, including family practice/internal medicine, ob-gyn, orthopedics, cardiology and pediatrics. In each webinar, you’ll find specialty-specific examples of appropriate documentation, such as a sample note for a diabetic patient on insulin who has experienced numbness in his feet, along with the correct ICD-10 coding assignments for each of the patient’s conditions.

To access these provider-specific webinars, visit CMS’s “Road to ICD-10” website at www.roadto10.org/webcasts.

OIG Outlines Self-Disclosure Protocol

Contrary to popular belief, contractors are required to self-disclose possible violations of Federal anti-fraud laws, just like Medicare-contracted physicians are. If a contractor believes it might have violated one of the federal regulations involving fraud, overpayments, conflict of interest, bribery or gratuity, it must inform the government.

If you are ever impacted by this requirement, you should submit your self-disclosure in writing via email, mail, or hand-delivery. The government offers a disclosure form that you can use to explain your situation, or you can include the relevant information via letter or other manner, the HHS Office of Inspector General (OIG) says in its recent “Contractor Self-Disclosure FAQs.”

To read how to self-disclose, or to peruse the frequently-asked questions that the OIG posted on this topic, visit oig.hhs.gov/faqs/contractor-faq.asp.