Download - Medicare Updates
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Provider Outreach and EducationNovember 16, 2010
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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.
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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
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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
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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
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The 2010 results are now available! Cahaba GBA Part A overall satisfaction score:
◦ 3.77
For questions or concerns:◦ Contact SciMetrika, LLC
[email protected] 1-800-835-7012
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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
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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
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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
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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
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• 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
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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
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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
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Computer base training courses
New account tutorial
Assessment Tools
Recorded educational events
Free enrollmentCourses available 24/7
Connect, Enroll, Learn @ Cahaba University
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Thank you
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