One of the biggest challenges to the provider community, including hospitals and critical access hospitals (CAH), is keeping up to date with current regulatory requirements, particularly when it comes to rules on coverage, coding, billing, and payment for services provided to beneficiaries under federal healthcare programs, including Medicare and Medicaid. For those of you who have taken one of our hospital or CAH Medicare Boot Camps, you probably remember discussing this early during the week, when we identified the major official sources of authority on Medicare rules, as well as some tips about how to efficiently keep yourselves up to date.
A few days after Briefings on APCs conducted the interview that appeared in last month's issue with W. Jeff Terry, MD, an AMA delegate from Mobile, Alabama, the AMA and CMS announced an accord regarding ICD-10.
In a joint announcement, the organizations said that CMS would not audit or deny Part B physician fee schedule claims for one year after ICD-10-CM implementation due to lack of specificity. While physicians will still be responsible for meeting medical necessity and LCD and NCD requirements, valid ICD-10-CM codes that include the appropriate first three characters will be sufficiently specific for Medicare claims.
Updates of MS-DRGs to the list subject to IPPS replaced devices offered without cost or with a credit policy; Revision to Medicare Code Editor (MCE) edit, procedure inconsistent with length of stay (LOS) for ICD-10-PCS respiratory ventilation, greater than 96 consecutive hours; and more!
Last week was a quiet week for CMS other than the release of the FY 2016 IPPS final rule on August 17 in the Federal Register. I thought I would take this opportunity to look at a billing issue about which I have recently been asked several questions. The questions generally revolve around how a hospital can bill for ambulance services when an inpatient leaves the facility for a procedure at another facility with the intention to return the same day. Unfortunately, since a hospital will trigger an edit that prevents the ambulance revenue code from being reported on the inpatient claim, it is assumed that the hospital must write off the transportation service. In fact, just the opposite is true based on CMS guidance.
