medicare updates

Provider Outreach and EducationNovember 16, 2010

This resource is not a legal document. This presentation was prepared as a tool to assist our providers.

This presentation was current at the time it was created.

Although every reasonable effort has been made to assure accurate information, responsibility for correct claims submission lies with the provider of services. Reproduction of this material for profit is prohibited.

Memorandum released August 9, 2010◦ www.cms.gov/AcuteInpatientPPS/o8a_Three_Day_Paymen

t_Window.asp Outpatient non-diagnostic services Clinically associated with the reason for a

patient’s inpatient admission Bundle on the inpatient claim and include all

diagnoses, procedures and charges Effective June 25, 2010

Released October 29, 2010◦ www.cms.gov/MLNMattersArticles/downloads/

MM7142.pdf Non-diagnostic services unrelated to the inpatient

claim◦ Clinically distinct or independent from the

reason for admission Separately billable to Part B Maintain documentation in medical records Beginning April 1, 2011, utilize condition code 51

Change Request 6960

Change Request 7080 elaborates upon these guidelines◦ For institutional claims that include span dates of service,

the “Through” date on the claim shall be used to determine the date of service for claims filing timeliness

Date of Service Timely Filing Guidelines

January 1, 2010 and after Within one year after date of service

October 1, 2009- December 31, 2009

December 31, 2010

October 1, 2008- September 30, 2009

December 31, 2010

The 2010 results are now available! Cahaba GBA Part A overall satisfaction score:

◦ 3.77

For questions or concerns:◦ Contact SciMetrika, LLC

MCPSS@scimetrika.com 1-800-835-7012

New HIPAA mandated electronic format

Current format is ANSI version 4010A1

Version 5010 is essential for the use of ICD-10-CM

Compliance date is January 1, 2012

www.cms.gov/ElectronicBillingEDITrans/18_5010D0.asp

Provider Action Checklist for a Smooth Transition

Checklist for Level I Testing New Health Care Electronic

Transactions Standards: Versions 5010, D.0., and 3.0 Fact Sheet

Preparing for Electronic Data Interchange Standards: The Transition to Versions 5010 and D.0. Fact Sheet

CMS has created new educational materials that inform providers of the changes associated with HIPAA 5010 and how they need to plan for their implementation

www.cms.gov/Versions5010andD0/40_Educational_Resources.asp#TopOfPage

ICD-9-CM has:

3, 4 or 5 digits Chapters 1 – 17 (all

numeric) Supplemental chapter

1st digit is alpha (E or V)

all others are numeric

ICD-10-CM has:

3-7 digits Digit 1 is alpha* (A-Z) Digit 2 is numeric Digit 3 is alpha* or

numeric Digit 4-7 are alpha* or

numeric

*Alpha is not case-sensitive

Date Compliance StepJanuary 1, 2010 Payers and providers should begin internal testing of Version 5010 standards

for electronic claims

December 1, 2010 Internal testing of Version 5010 must be complete to achieve Level I Version 5010 compliance

January 1, 2011 •Payers and providers should begin external testing of Version 5010 for electronic claims•CMS begins accepting Version 5010 claims•Version 4010 claims continue to be accepted

December 31, 2011 External testing of Version 5010 for electronic claims must be complete to achieve Level II Version 5010 compliance

January 1, 2012 •All electronic claims must use Version 5010•Version 4010 claims are no longer accepted

October 1, 2013 •Claims for services provided on or after this date must use ICD-10 codes for medical diagnosis and inpatient procedures•CPT codes will continue to be used for outpatient services

• November 2009 CERT Error – 7.8% for all fee-for-service providers

CERT Errors• Medical necessity• Insufficient documentation• Incorrect coding

65%

23%

8%

Medical Necessity

Insufficient Documentation

Incorrect coding

Connolly Consulting, Inc. handles the Cahaba GBA workload

Remark code N432 is used to identify RAC claims

Demand letter is issued by the RAC

• Medical records 45 days Paper, CD or DVD

http://www.connollyhealthcare.com/RAC/pages/approved issues.aspx

Final rule announced on July 13, 2010 Initiated by the American Recovery and

Reinvestment Act of 2009 Incentive payments will be available Eligible hospitals can register starting January 2011

◦ Subsection (d) hospitals paid under IPPS◦ Critical Access hospitals◦ Medicare Advantage hospitals

Computer base training courses

New account tutorial

Assessment Tools

Recorded educational events

Free enrollmentCourses available 24/7

Connect, Enroll, Learn @ Cahaba University

Thank you

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