Medicare Updates

Medicare Updates Provider Outreach and Education November 16, 2010

Disclaimer 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.

3 Day Payment Window • Memorandum released August 9, 2010 • www.cms.gov/AcuteInpatientPPS/o8a_Three_Day_Payment_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

Change Request 7142 • 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

Timely Filing • 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

Medicare Contractor Provider Satisfaction Survey • 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

HIPAA 5010 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

HIPAA 5010 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 • 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

ICD-10 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 www.cms.hhs.gov/ICD10/

ICD-10 and Version 5010Compliance Timelines CMS sponsored calls found at: http://www.cms.gov/ICD10/02c_CMS_Sponsored_Calls.asp#TopOfPage

Comprehensive Error Rate Testing (CERT) • November 2009 CERT Error – 7.8% for all fee-for-service providers • CERT Errors • Medical necessity • Insufficient documentation • Incorrect coding

Recovery Audit Contractor (RAC) http://www.connollyhealthcare.com/RAC/pages/approved issues.aspx • 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

Electronic Health Records (EHR) • 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 www.Cms.Gov/ehrincentiveprograms/01_overview.Asp#topofpage

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Medicare Updates