Medicare Compliance & Reimbursement

A landmark bill, codifying into state law in Massachusetts, was passed by the Senate on June 26 to ensure that registered nurses who serve in the state’s hospitals’ intensive care units will not be assigned more than one patient. In specific circumstances two patients may be assigned based on the assessment of the nurses of that unit.

“We thank Leader Rosenberg, Senate President Therese Murray and Speaker Robert DeLeo for their efforts to protect patients,” said Donna Kelly-Williams, RN, president of the Massachusetts Nurses Association/National Nurses United (MNA/NNU) in a press release.

The purpose of this measure is to set “an enforceable maximum limit on the number of patients a nurse can care for at one time... (to) protect the most critically ill patients,” she added.

To read more on this, see: prnmedia.prnewswire.com/news-releases/agreement-reached-on-landmark-measure-to-protect-patients-by-setting-safe-patient-limits-for-nurses-in-all-intensive-care-units-264726311.html

CMS Reveals Auditors’ Findings Regarding AWVs

Although annual wellness visits (AWVs) have been around for a while, you may still find them a bit of a mystery. And that seems to be the case for quite a few practices, if the Recovery Audit Contractor (RAC) findings are any indication.

CMS published the most common error seen among AWV claims (G0438-G0439) in its January Medicare Quarterly Provider Compliance Newsletter.

The biggest culprit? Repeated billing of G0438 (Annual wellness visit…initial visit). You can only collect for the initial visit once per beneficiary’s lifetime. That means that if the patient has had an AWV already — even if it was several years ago — you should report G0439 (Annual wellness visit…subsequent visit) for the successive annual wellness visits.

However, auditors don’t appear to only be seeking more money from practices. The Newsletter also outlined several instances where Medicare auditors discovered that MACs underpaid practices. For instance, auditors found that one provider reported 99215 for a new patient consultation. After reviewing the records, the auditor discovered that the physician deserved more reimbursement because he should have reported 99205, since it was a new patient and not an established one. The MAC then reimbursed the practice for the difference.

CMS Finally Releases Stats on ICD-10 Testing

Although many practices were eager to hear news about CMS’s ICD-10 testing and whether it was successful, the agency was mum on the issue for what seemed like an eternity — until now.

During a meeting of the Standards Subcommittee of the National Committee on Vital and Health Statistics (NCVHS) in June, CMS’s Denesecia Green denied that end-to-end testing was permanently cancelled — instead referring to the testing as simply being delayed. “There will be testing,” Green said to the group.

In addition, the agency’s John Evangelist said that the March 3-7 ICD-10 testing was quite successful, with 127,000 ICD-10 claims finding their way through the fee-for-service claims system. The national average for claims success was 89 percent, although some regions successfully processed 99 percent of the claims submitted. Among the 2,600 entities that submitted ICD-10 claims during testing, more than 50 percent were clearinghouses, and the rest were physician practices, hospitals, labs, ASCs, dialysis facilities, billers, home health providers and ambulance services.

For more on the ICD-10 transition that will take place on Oct. 1, 2015, visit the ICD-10 website at www.cms.gov/medicare/coding/icd10.

Diagnosis Freeze May Thaw

Medicare has extended its ICD-9 code freeze through Oct. 1, 2015, but that doesn’t mean your diagnosis coding updating will be on hold until then.

Reminder: CMS has said for Oct. 1, 2014, there will be limited code updates to both the ICD-9 and ICD-10 code sets to capture new technologies and diseases. For Oct. 1, 2015, there will be limited code updates to ICD-10 code sets to capture new technologies and diagnoses, but no updates to ICD-9. Then, regular updates to ICD-10 begin on Oct. 1, 2016.

“What we do know is that, despite ongoing code freezes, changes have been made in the ICD-10-CM code set including changes to instructions in the tabular list, corrections to the alphabetical index and tweaks to the guidelines themselves,” says coding expert Lisa Selman-Holman of Selman-Holman & Associates and CoDR — Coding Done Right in Denton, Texas. “So don’t kid yourself that nothing is new.”

Need Guidance On Signature Requirements? CMS Has Your Document.

Whether you’re a physician certifying terminal illness for hospice, ordering a diagnostic test or requesting DME supplies, Medicare needs your signature. But many practices are unclear regarding what specifics you must include when you’re signing an order or prescription.

CMS has come to the rescue, offering specific guidance on signature requirements in 12 different articles on the matter. From an overall view regarding Medicare’s rules to specialty-specific signature regs, you can keep this handy resource bookmarked on your computer for reference whenever you have a question about signing your medical documents.

All of the links are in MLN Matters SE1419, “Medicare Signature Requirements: Educational Resources for Health Care Professionals,” which you can find at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1419.pdf.

You Could Get A Prison Sentence For HIPAA Violations

A relatively new development is terrorizing healthcare providers — criminal charges stemming from violating HIPAA.

Case in point: A grand jury indicted a Longview, TX man, Joshua Hippler, on charges of Wrongful Disclosure of Individually Identifiable Health Information, stemming from HIPAA violations that occurred from Dec. 1, 2012 through Jan. 14, 2013, according to a July 3 press release from the U.S. Attorney’s Office, Eastern District of Texas.

During that time, Hippler worked for an East Texas hospital and allegedly accessed protected health information (PHI) with the intent to use the information for personal gain, announced U.S. Attorney John M. Bales.

The criminal charges came about after HHS Office of Inspector General (OIG) agents conducted an investigation into the purported HIPAA violation. If convicted, Hippler could face up to 10 years in prison.