tci Medicare Compliance & Reimbursement - 2014 Issue 22
Industry Notes: CMS Clears Up the Most Common ICD-10 Myths
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Article Overview
This industry update reviews several Medicare, coding, and compliance topics of interest to health care billers, coders, and compliance staff. It covers CMS efforts to clarify widespread ICD-10 misunderstandings, audit findings related to prolonged service claims, and reported trends from early HIPAA privacy, security, and breach-notification audits. The article is relevant for readers tracking coding administration, documentation concerns, and federal compliance priorities.
Why This Topic Matters
The piece helps readers understand which misconceptions and compliance problem areas are drawing attention from CMS, Medicare contractors, and OCR. It is useful for organizations monitoring coding education, claim documentation, and audit readiness.
Article Sections
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CMS clears up common ICD-10 myths
A CMS publication is discussed as a source of clarification about frequently repeated misconceptions surrounding ICD-10 implementation. The section focuses on general ICD-10-CM and ICD-10-PCS education and transition-related concerns.
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This MAC highlights the most common prolonged service errors
The article summarizes audit results from a Medicare contractor involving prolonged service claims and common documentation-related problems. It also notes the contractor’s broader reminders about claim support and recordkeeping.
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HIPAA audits reveal that smallest entities had most trouble staying compliant
This section reviews reported results from Phase 1 OCR audits of covered entities and describes overall patterns across the privacy, security, and breach-notification standards. It highlights how audit findings were distributed among provider and non-provider entities.
What You Will Learn
- How CMS is addressing common misconceptions about ICD-10 implementation
- What kinds of prolonged service claim issues were identified in a Medicare audit review
- What early HIPAA audit results suggested about compliance patterns across covered entities
- Which broad compliance standards drew the most attention in the reported OCR audits
Who Should Read This
- Medical coders
- Billing staff
- Compliance officers
- Revenue cycle staff
- Health care administrators
- HIPAA privacy and security personnel
Codes Discussed
Code Ranges Discussed
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