Medicare Compliance & Reimbursement

If you’ve been waiting by the phone to find out if you’ve been selected to participate in ICD-10 end-to-end testing, you may want to take a break. Novitas Solutions, a Part B payer, announced recently that until CMS provides additional guidance regarding the ICD-10 delay, “Medicare will not be announcing the participants selected for the planned July 2014 end-to-end testing,” Novitas says. At this point, CMS has not yet announced the new ICD-10 implementation date.

Background: As most readers know, CMS intended to launch an end-to-end ICD-10 testing period in July, which differs from the previous ICD-10 tests. During the more in-depth testing, providers were expected to submit ICD-10 code claims to their MACs and would receive a remittance advice and adjudication.

Applicants were expected to be notified by April 14 regarding whether they’d been selected, but at this point, it looks like that may not transpire. Keep an eye on your MAC’s website to determine whether the testing will be rescheduled or not.

‘New’ Vs. ‘Established’ Issue Causes $7.5 Million in Incorrect Hospital Payments

Even if you’ve got Medicare’s “three year” new patient rule burned into your brain, the reality is that big mistakes do happen in this area, and those errors are costly.

That’s the word from a March 28 OIG report entitled “CMS Did Not Always Correctly Make Clinic Visit Payments to Hospitals,” which reveals that $7.5 million in incorrect payments went to hospitals for established patients’ clinic visits in 2010 and 2011 because they were coded as new patients. “The Medicare payment for clinic visits depends on whether the patient is identified as ‘new’ or ‘established’ at a particular hospital,” the OIG said in its report. “If the patient has a hospital medical record that was created within the past three years, that patient is considered an established patient at the hospital.”

As a result of the audit, CMS has asked MACs to instruct hospitals on stronger compliance controls to ensure that the clinic visits are billed properly. If your hospital-based clinic sees Medicare patients, be sure to check the patients’ records to confirm whether they are new or established before you report your services.

Recovery Auditors Have Until June 1 To Conduct Automated Reviews

Don’t be lulled into complacency by the break in Addition Documentation Requests (ADRs) from recovery auditors. Feb. 28 marked the current recovery contractors’ deadline for sending out new ADR communications, but they can continue to conduct automated reviews through June 1, and they are sure to follow through on reviews that commenced before the ADR halt.

Mark your calendar: Providers have 45 days to respond to an ADR and recovery auditors have up to 60 days to make a determination on the claim. June 1 is the last day a recovery auditor can send payment files to the MACs or adjustment.