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Find-A-Code Focus Newsletter

2014 October Articles


ICD-10-CM Did you know... What are GEMs?

October 30, 2014
GEMs is a term you will be very familiar with once you start your ICD-10 transition. General Equivalence Mappings (GEMs) for the ICD-10-CM diagnostic codes were created in a joint effort by CMS and The Centers for Disease Control and Prevention (CDC). GEMs can help you to map codes forwar... Read More

Is it Required to Pay 2% on Incentive Payments Earned for 2013?

October 24, 2014
Yes, earned incentive payments will be deducted by 2%; President Obama has required this by law.  President Obama issued a sequestration order on March 1, 2013. Under these mandatory reductions, PQRS incentive payments made to eligible professionals and group practices have been reduced by 2%.... Read More

Hospital-Acquired Conditions (HAC) in Acute Inpatient Prospective Payment System (IPPS) Hospitals

October 24, 2014
The Deficit Reduction Act of 2005 (DRA) requires a quality adjustment in Medicare Severity Diagnosis Related Group (MS-DRG) payments for certain hospital-acquired conditions. CMS has titled the provision “Hospital-Acquired Conditions and Present on Admission Indicator Reporting” (HAC &am... Read More

DMEPOS HCPCS Jurisdiction List

October 24, 2014
HCPCS codes and where to bill them: Local Carrier? DME MAC? Maybe Both? See the complete list here: NGS -HCPCS Jurisdiction List... Read More

ICD-10 TIP of the MONTH: The Documentation of Procedures

October 24, 2014
To assist you in understanding the key definitions related to documenting procedures in ICD-10, see below for a list of terms to be used in your documentation. Brought to you by Crozer Keystone ICD-10 tip of the month. Examples: Alteration - Modifying the anatomic structure of a body part without... Read More

Incarcerated Beneficiary Update - CMS

October 24, 2014
In 2013, CMS initiated recoveries from providers and suppliers based on data that indicated a beneficiary was incarcerated on the date of service. CMS subsequently discovered that some of the data used was incomplete. Since some of these recoveries might have been erroneous, CMS initiated refun... Read More

Patient Discharge Status Codes and Hospital Transfer Policies - Clarification

October 24, 2014
A patient discharge status code is a two-digit code that identifies where the patient is at the conclusion of a health care facility encounter or at the end time of a billing cycle. It belongs in Form Locator 17 on a UB-04 claim form or its electronic equivalent in the HIPAA compliant 837 format. T... Read More

CMS Announces 2013 eRx Incentive Program Payments are Now Available

October 24, 2014
CMS is pleased to announce that the 2013 Electronic Prescribing (eRx) Incentive Program incentive payments are now available for eligible professionals and group practices who submitted data for Medicare Physician Fee Schedule Part B services provided January 1, 2013 through December 31, 2013. As r... Read More

Clarification of Equipment and Approach in Coding

October 24, 2014
When determining the type of approach taken in a surgical procedure, it is important to review not only the title of the report but also the body of the report to locate the method used. Somewhere in the body of the report, and always preferably in the title, scope, endoscope, endoscopy or whatever... Read More

New: 2014 October Edition of the Medicare Quarterly Provider Compliance Newsletter

October 15, 2014
Find-A-Code has posted the October 2014 edition of the Medicare Quarterly Provider Compliance Newsletter at:http://www.findacode.com/medicare/medicare-quarterly-provider-compliance-newsletter.htmlTopics include: Recovery Auditor Finding: Hospital Discharge Day Management Service - Different Provi... Read More

CMS announces re-opening MU applications until November 30, 2014

October 13, 2014
CMS is announcing its intent to reopen the submission period for hardship exception applications for eligible professionals and eligible hospitals to avoid the 2015 Medicare payment adjustments for not demonstrating meaningful use of Certified Electronic Health Record Technology (CEHRT). The new d... Read More

PQRS - 2nd Quarter Interim Feedback Dashboard Reports Now Available

October 13, 2014
Physician Quality Reporting System (PQRS) 2nd Quarter interim Feedback Dashboard reports are now available.  For eligible professionals and submitted data for claims sent in January 01, 2014 and June 30, 2014.  Data is available on a quarterly basis in order to monitor the status of c... Read More

Claims Processing and the Remittance Advice

October 13, 2014
After a claim has been submitted and a reimbursement decision has been made, you or your billing agent receive a Remittance Advice (RA). The RA is a notice of payments and adjustments that the MAC produces as a companion to claim payments or an explanation when there is no payment. It features valid... Read More

CMS Transitioning to ICD-10. Register Now!

October 09, 2014
Wednesday, November 5; 1:30-3pm ET To Register: Visit MLN Connects™ Upcoming Calls. Space may be limited, register early. HHS has issued a rule finalizing October 1, 2015 as the new compliance date for health care providers, health plans, and health care clearinghouses to transition to ICD-1... Read More

Effective Billing Dates for new CMS Providers

October 09, 2014
Submitting the CMS-855 Enrollment Application and Billing Effective Date Changes As of May 14, 2012, the billing effective date can be made retroactive as far back as 30 calendar days from the date the application was received in Medicare's office. Provider offices must submit the CMS 85... Read More

OSHA- Hazard Communication Standard Final Rule (Globally Harmonized System)

October 06, 2014
The Hazard Communication Standard in 1983 gave workers the "right to know," but the new Globally Harmonized System gives workers the "right to understand."  What you need to do and when: Chemical users: Continue to update safety data sheets when new ones become available, provide training o... Read More

ICD-10 and Clinical Documentation CME/CE

October 02, 2014
MedScape is offering a free training activity for healthcare providers who will be involved in clinical documentation with ICD-10.   This activity is to make providers aware of the key elements fo good clinical documentation.CME/CE Released: 09/15/2014 ; Valid for credit through 09/15/201... Read More

Healthcare Fraud Investigations in FY 2013

October 02, 2014
Enforcement Actions in FY 2013: the Department of Justice (DOJ) opened 1,013 new criminal health care fraud investigations involving 1,910 potential defendants. Federal prosecutors had 2,041 health care fraud criminal investigations pending, involving 3,535 potential defendants, and filed criminal c... Read More

Healthcare Fraud Investigations in FY 2013

October 02, 2014
Enforcement Actions in FY 2013: the Department of Justice (DOJ) opened 1,013 new criminal health care fraud investigations involving 1,910 potential defendants. Federal prosecutors had 2,041 health care fraud criminal investigations pending, involving 3,535 potential defendants, and filed criminal c... Read More

NCCI 20.3 Analysis - by Frank Cohen

October 01, 2014
I have completed my analysis of the NCCI 20.3 release and following are my general findings:New Edits There are 5,247 new edit pairs, bringing the total to number of active edits to 1,340,210 The top four codes for column 1 are C9740, C9739, 0356T and 347T, but these only account for just over 16%... Read More

Patient Electronic Access Tipsheet - Measure Compliance

October 01, 2014
MEASURE COMPLIANCE - Meeting the Patient Electronic Access Objective Starting in 2014, CMS requires that providers participating in both Stage 1 and Stage 2 of the EHR Incentive Programs must meet the Patient Electronic Access objective, which gives patients access to their health informa... Read More

Virtual Credit Cards -A new trend in trying to keep up with E-Health

October 01, 2014
Beware of the changes sneaking in as “money streams” in the name of EFT standards. Virtual Credit Cards are being used in provider’s offices as payments from payers; clearinghouses are starting to offer this service as well. Effective January 1, 2014, health plans were required to... Read More

HHS Announces $99 Million in New Grants to Improve Mental Health Services for Young People

October 01, 2014
Health and Human Services Secretary Sylvia M. Burwell announced today $99 million to train new mental health providers, help teachers and others recognize mental health issues in youth and connect them to help, and increase access to mental health services for young people. Read the article here:&n... Read More

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