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What's New For Providers
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Note: This article was revised on February 2, 2012, to show that, effective with the release of CR7717, the requirement for SNF and SB providers to submit occurrence code 16 to indicate the last day of therapy services is discontinued. All other information is the same. This article is based on Change Request (CR) 7717 which discontinues the SNF and SB provider reporting requirement for reporting Occurrence Code 16 and updates instructions for assessment date reporting. CR7717 updates current Medicare system edits to add the following Assessment Indicators (AIs) that only require one Occurrence Code 50 (Assessment date reporting) for an assessment that produces two Health Insurance Prospective Payment System (HIPPS) codes required on the claim: 0A, 0B, 0C, 1A, 1B, 1C, 2A, 2B, 2C, 3A, 3B, 3C, 4A, 4B, 4C, 5A, 5B, and 5C. Published Online:
Monday, February 06, 2012
Applicable States:
[ARK-Part A] [LA-Part A] [MS-Part A]
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This article is based on Change Request (CR) 7706 which clarifies billing instructions in the "Medicare Claims Processing Manual" when Life Time Reserve (LTR) days exhaust during the non-outlier portion of an Inpatient Prospective Payment System (IPPS) stay. There are no policy changes with this instruction and this article serves as informational by providing two examples conveyed in CR7706 in order to provide clarification. Published Online:
Monday, February 06, 2012
Applicable States:
[ARK-Part A] [LA-Part A] [MS-Part A]
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The Centers for Medicare & Medicaid Services (CMS) is extending the licensure deadline for the Round 2 and national mail-order competitions of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program. The original licensure deadline required suppliers to have all required state licenses on file with the National Supplier Clearinghouse (NSC) and indicated in the Provider Enrollment, Chain, and Ownership System (PECOS) before submitting a bid. NEW DEADLINE: Bidding suppliers must now ensure that copies of all applicable state licenses are RECEIVED by the NSC on or before Tuesday, May 1, 2012. Published Online:
Friday, February 03, 2012
Applicable States:
[ARK-Part A] [LA-Part A] [MS-Part A] [ARK-Part B] [LA-Part B]
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Prior to the implementation of HIGLAS (the Healthcare Integrated General Ledger Accounting System), Medicare’s Multi-Carrier System (MCS) created just one check per sender, National Provider Identifier (NPI), or legacy ID. Each sender / NPI / legacy ID was able to have multiple receivers of the electronic remittance; MCS would use the sender ID submitting each claim to aid in determining to whom the remit should be sent. For each check that was created, MCS also created an electronic remittance advice (ERA), which accurately reported the payment amount for that ERA.
When a MAC transitions to HIGLAS, only one check can be produced per NPI/legacy ID. The old MCS system logic, which took the sender information into account when generating the remit, was not changed when MACs began their transition to HIGLAS; in some instances, the result was a remittance advice that did not contain all of the claims processed in a given cycle or a remittance advice containing payments that did not total to the EFT/check amount.
Published Online:
Friday, February 03, 2012
Applicable States:
[ARK-Part A] [LA-Part A] [MS-Part A] [ARK-Part B] [LA-Part B]
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As a reminder, the Outpatient Prospective Payment System (OPPS) Final Rule that was released on Wednesday, November 30, 2011, stated that, in order for a physician-owned hospital to receive an exception to the prohibition on facility expansion, it must satisfy eligibility criteria to qualify as an "Applicable Hospital" or "High Medicaid Facility."
CMS has published additional guidance at http://www.CMS.gov/PhysicianSelfReferral/85_Physician_Owned_Hospitals.asp that will address the process for accessing data, as well as provide sample computations for determining whether a hospital satisfies the respective criteria. Questions regarding this issue can be emailed to POHexceptions@cms.hhs.gov.
Published Online:
Friday, February 03, 2012
Applicable States:
[ARK-Part A] [LA-Part A] [MS-Part A] [ARK-Part B] [LA-Part B]
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With the implementation of Accredited Standards Committee (ASC) X12 Version 5010 transactions for acknowledgements (TA1, 999, and 277CA), Medicare Fee-for-Service is recommending the use of unique numbering for several enveloping control / reference numbers built into the Version 5010 claims transitions. Using unique numbering for the IAS13, ST02, and BHT03 data elements on the inbound 837 Institutional and Professional claims will allow Medicare trading partners to easily match submitted claims with the acknowledgement transactions. Published Online:
Friday, February 03, 2012
Applicable States:
[ARK-Part A] [LA-Part A] [MS-Part A] [ARK-Part B] [LA-Part B]
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The Centers for Medicare & Medicaid Services (CMS) will host a National Provider Call Tuesday, February 21; 1:30 – 3:00 p.m. ET on the Physician Quality Reporting System & Electronic Prescribing Incentive Program. Subject matter experts will provide an overview on claims-based reporting for both programs, followed by a question and answer session. In order to receive the call-in information, you must register for the call. Registration will close at 12:00 p.m. on the day of the call or when available space has been filled; no exceptions will be made, so please register early. For more details, including instructions on registering for the call, please visit http://www.eventsvc.com/blhtechnologies. Published Online:
Friday, February 03, 2012
Applicable States:
[ARK-Part B] [LA-Part B]
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Tuesday, January 3rd, was the one-year anniversary of the start of registration for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. Over the past year, there has been a tremendous amount of interest in the incentive programs as providers across the country have implemented EHRs. Published Online:
Friday, February 03, 2012
Applicable States:
[ARK-Part A] [LA-Part A] [MS-Part A] [ARK-Part B] [LA-Part B]
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CMS is proud to announce that after a review of collected feedback, enhancements and changes have recently been made to the EHR Information Center Interactive Voice Response (IVR) system.
Among these caller-friendly revisions is a new feature to assist with Hot Topics, including registration and attestation, as well as updated Password Reset menus. These improvements will enable eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) to obtain information about the EHR Incentive Program more easily and efficiently.
Published Online:
Friday, February 03, 2012
Applicable States:
[ARK-Part A] [LA-Part A] [MS-Part A] [ARK-Part B] [LA-Part B]
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Obama Administration officials and a breadth of representatives from across the healthcare system met in Washington on Thursday, January 26th for a day-long meeting to explore how they can collaborate and improve the quality of healthcare while at the same time lowering costs.
The Obama Administration also released a new report highlighting the success of the Center for Medicare & Medicaid Innovation. Created by the Affordable Care Act, the Innovation Center has already worked to test and support innovative new healthcare models that can reduce costs and strengthen the quality of healthcare. The CMS Innovation Center Year-in-Review report is available at http://www.Innovation.CMS.gov/documents/pdf/CMMIreport_508.pdf.
Published Online:
Friday, February 03, 2012
Applicable States:
[ARK-Part A] [LA-Part A] [MS-Part A] [ARK-Part B] [LA-Part B]
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