Medicare Compliance & Reimbursement

Plus: CMS correcting errors, helping with e-prescribing incentive program.

President-elect Barack Obama is due to appoint a new CMS Administrator any day now, but some pundits fear that the new CMS head might be taking on the previous administration's problems with the new post.

According to a Dec. 9 article in The Hill, Obama "plans significant changes in the way Medicare, Medicaid, and SCHIP are run, and the president-elect's choice for administrator of CMS will be the one tasked with putting those new policies in place."

That's in addition to overseeing a $676 billion annual budget and 4,400 employees.

Look to MLR for more information as the new administration takes shape.

IN OTHER NEWS ...

• If you've received a few inexplicable denials from your payer, the problem might be due to your carrier's computer software and not your coding prowess. On Dec. 10, National Government Services, a Part B payer in New York, issued

an alert noting that "some Part B providers in New York are receiving errors on the Part B Validation Report for invalid diagnosis codes. National Government Services has identified the cause of this problem and has made the changes necessary

to correct the issue," the directive from the payer indicated.

If you received these errors, you should resubmit the erroneously denied claims, the carrier advises.

•CMS has added more people to the list of professionals who are exempt from the durable medical equipment accreditation requirements that take place Sept. 30,  2009. Orthotists, prosthetists, opticians, and audiologists are now on the

exempt list, CMS says.

Professionals such as pedorthotists, mastectomy fitters, ortho-paedic fitters/technicians, and athletic trainers are not exempt, clarified CMS' Sandra Bastinelli in the Dec. 9 Open Door Forum for home care providers.

• Hospice patients with the longest lengths of stay are those with Alzheimer's disease and related disorders, according to the latest non-cancer length of stay (NCLOS) data from RHHI Palmetto GBA. About 31 percent of hospice patients

with Alzheimer's had LOS exceeding 210 days in the first half of 2008. The shortest LOS was for renal disease, where only 5 percent had stays exceeding 210 days, Palmetto says in its December newsletter for providers.

For more NCLOS data from Palmetto, including how to request your own NCLOS rates, go to www.palmettogba.com/rhhi, click on "Hospice" under the "Articles" heading in  the left column, and scroll down to the Oct.24 entry.

• CMS is offering advice on how to make the most of the e-prescribing incentive program. As of Jan. 1, you could benefit from Medicare's new e-prescribing bonus  system. But if you aren't sure quite what it will entail, CMS has some

guidance that could give you some aid.

The CMS document, "Medicare's Practice Guide to the E-prescribing Incentive Program" offers tips on determining whether you are eligible for the incentive program, finding the right type of software, and submitting your claims to your carrier.

One of the most important factors you should know about the program is that you have to use a "qualified" eprescribing system if you want to participate. You'll also need to know how to determine whether your system is qualified, which the

document instructs you how to do.

In addition, you'll have to report on the e-prescribing quality measure, which requires you to bill an appropriate denominator code along with an applicable G code on  more than 50 percent of applicable cases for the numerator.

The information is all spelled out in the CMS document, which is available on the web at www.cms.hhs.gov/partnerships/downloads /11399.pdf.