CMS Open Door Forum #2: Part A to Part B Rebilling Demonstration – Recordings & Transcripts Available Here
We recorded the second CMS Special Open Door Forum for the Part A to Part B Rebilling Demonstration, conducted by CMS on December 8, 2011. The project will allow hospitals to rebill for 90 percent of the Part B payment when a Medicare contractor denies a Part A inpatient short stay claim as not reasonable and necessary due to the hospital billing for the wrong setting. Contact: ABRebillingDemo@cms.hhs.gov
Register or Login for access to the recording. A transcript will also be available, late on Friday, December 9. (We’re geeks. Maybe CMS should use us for this stuff?)
Find the recording and transcript for the first Open Door Forum by CMS on this subject, HERE.
HHS extends Stage 2 Meaningful Use deadline for early adopters
On November 30, 2011, the United States Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced that eligible providers that satisfy the Medicare and Medicaid EHR Incentives Program Stage 1 Meaningful Use criteria in 2011 may wait until 2014 to comply with CMS‘s Stage 2 criteria.
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CMS Open Door Forum: Part A to Part B Rebilling Demonstration – Recording Available Here
We recorded the CMS Special Open Door Forum for the Part A to Part B Rebilling Demonstration. The project will allow hospitals to rebill for 90 percent of the Part B payment when a Medicare contractor denies a Part A inpatient short stay claim as not reasonable and necessary due to the hospital billing for the wrong setting. Contact: ABRebillingDemo@cms.hhs.gov
Register or Login for access to the recording. A transcript will also be available, within 24 hours. (Natch. We’re geeks.)
New CMS RAC Audits and Demonstration Projects
CMS recently announced several new demonstration projects. See them here.
Two of the three projects are of importance to us here at RAC Shadow.
Recovery Audit Program Prepayment Review Demonstration: Will allow Medicare Recovery Auditors (RACs) to review claims before they are paid to ensure that the provider complied with all Medicare payment rules. Contact: RAC@cms.hhs.gov
There are no calls or documents available on the CMS site for this project.
Part A to Part B Rebilling Demonstration: Will allow hospitals to rebill for 90 percent of the Part B payment when a Medicare contractor denies a Part A inpatient short stay claim as not reasonable and necessary due to the hospital billing for the wrong setting. Contact: ABRebillingDemo@cms.hhs.gov
The Rebilling project has a Q&A document available: AB Rebilling Demonstration Q&A as of 11/18/11 [PDF, 35.2 KB]
And an Open Door Forum is scheduled on two days for the Rebill Project:
CMS Publishes New RAC Statement of Work (updated)
CMS published a new version of the Recovery Audit Contractor (RAC) Statement of Work, this morning, in a document dated September 1, 2011. Changes are few, but most significantly, the document now includes the Semi-Automated Review, as an integrated, fully approved method of audit and review. Other changes include paragraphs including the Discussion Period and the posting of new issues to the RAC websites. Continue reading
CMS Updates RAC FAQ on Complex Reviews
CMS recently updated the FAQ page on their website, concerning Recovery Audit Contractor (RAC) complex reviews. Effectively, the RAC can now perform Medical Necessity reviews on records already reviewed for DRG Validation, without further notification or requests being sent to the provider .
CMS Video: Transition to D.0 and ICD-10, an Overview
(The 2 minute preview in the article is an edited version of the complete webinar, available at the end of the article.)
CMS presented a webinar about the coming changes in the industry under the ICD-10 coding system and the National Council for Prescription Drug Program’s (NCPDP) D.0 (pronounced “Dee-dot-Zero”) Transaction and Code Set Standards. The webinar was hosted by the NCPDP. A version of the recorded webinar is available from the NCPDP site, but cannot be downloaded. RAC Shadow provides a version that is easily downloaded and editable. It can be used by any provider, and is useful to provide an overview of both the ICD-10 and D.0 standards.
At the end of this article, you will find links to the download plus a player to watch the complete video here at The RAC Shadow.
ADR Limits for CMS RACs Increase For Smaller Providers
CMS posted “Additional Documenation Limit Update for Providers” today, a document dated August 15, 2011, outlining changes for the number of Additional Documentation Requests (ADR) that a Recovery Audit Contractor can request from providers, excluding suppliers and physicians. The change takes effect today, August 22, 2011.
CMS Posts Final Rule for FY2012 Hospital IPPS
The Centers for Medicare and Medicaid Services (CMS) just released the final inpatient prospective payment system (IPPS) rule for Fiscal Year (FY) 2012. While covering reimbursements for approximately 3,400 acute care hospitals, the final rule also updates reimbursement policies for more than 400 long-term care hospitals (LTCHs).
According to CMS, total Medicare operating payments to acute care hospitals for inpatient services will increase by 1.1 percent ($1.13 billion) for FY 2012, compared with FY 2011. Medicare reimbursements to LTCHs during the same period are projected to increase by 2.5 percent ($126 million).
The final IPPS rule also contains provisions designed to strengthen the relationship between reimbursements and quality of care. For example, it expands quality measures that must be reported under the Hospital Inpatient Quality Reporting Program by focusing on prevention of healthcare-related infections and readmissions.
Also, the final rule sets forth initial readmissions measures that will be included in a forthcoming Hospital Readmissions Reduction Program, as mandated by the Patient Protection and Affordable Care Act (PPACA). The program will apply to rates of readmissions for heart failure, acute myocardial infarction (heart attack) and pneumonia. CMS indicated that it plans to continue the implementation of this program in future rulemaking. The program itself is set to begin in FY 2013.
The final IPPS rule takes effect on October 1, will be published in the Federal Register on August 18.
However, you can download a copy of the rule now. [PDF, 4.09MB, 1492 pgs]
CMS Provider Compliance Group To Address OIG and RAC Issues: August 23-25,2011
CMS announced a series of calls on specific Medicare program vulnerabilities identified in HHS Office of Inspector General (OIG) reports. Some of the issues being addressed on the calls correspond to some recently posted RAC Approved Issues. Since CMS has included specific emails for sending in questions before the sessions, provider may wish to compose and send off questions about these issues. The issues listed by CMS are vague enough as to allow for quite a broad range of questions, particularly for the Day Two topics. Find a complete PDF of topics, dates and times below. Continue reading