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More Bundled Medicare Payments Ahead: ACE Demonstration Tests Concept for Acute Care
September
2008
With the recent announcement of the Acute Care Episode (ACE) Demonstration, the Centers for Medicare & Medicaid Services (CMS) sent a signal to the industry that it intends to head in the direction of bundled payments for inpatient physician and hospital services, at least for select procedures. The ACE Demonstration will test whether the new payment structure results in cost efficiencies and quality improvements for Medicare and its beneficiaries.
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Physician Signatures on Test Requisitions: CMS Clarifies Medicare Policy
July
2008
Has your laboratory received documentation requests from the comprehensive error rate testing (CERT) contractor (AdvanceMed) asking for an original requisition signed by the ordering physician? If so, you're not alone. According to a letter from the American Clinical Laboratory Association (ACLA) to the Centers for Medicare & Medicaid Services (CMS) in mid-March, many laboratories have received such requests. What's more they received notification that the testing is inappropriate, and the claim will be denied if no such requisition can be produced. (Don't panic! It's not true.)
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Codes Subject to CLIA Edits in 2008: CMS Issues a List of Eight Codes
July
2008
As you probably know, the CPT codes that CMS considers to be laboratory tests under CLIA, which require a certification, change each year. In Transmittal 1471 (February 29), CMS informed Medicare carriers and Part A/B Medicare administrative contractors (MACS) about the 2008 codes that are subject to CLIA edits and also about those that are now excluded from CLIA edits.
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Billing Emend® Tri-Pak on Outpatient Claims: Clarifications Issued on Wrongful Denials
May
2008
It has come to the attention of the Centers for Medicare & Medicaid Services (CMS) that payment denials are occurring for the three-drug combination of oral anti-emetics contained in the Emend Tri-Pak because two doses of anti-emetics are sent home with the patient. The denial of these claims resulted from a misinterpretation by the Medicare fiscal intermediaries (FIs) of a policy concerning the billing of take-home drugs.
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Ordering Diagnostic Tests in Non-Hospital Settings: CMS Discovers and Issues Missing Guidelines
March
2008
Although it's been several years since the Centers for Medicare & Medicaid Services (CMS) transitioned from the Medicare Carriers Manual (MCM) to the Internet-only manual, it has just gotten around to incorporating language it says it "inadvertently omitted" related to the requirements for ordering, and following orders for, diagnostic tests in non-hospital settings.
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Final 2008 Hospital OPPS Rules Issued: Details for Pharmacy Departments Abound
January
2008
The 2008 interim and final rule with comment period for the Medicare hospital outpatient prospective payment system (OPPS) weighs in at 1,969 pages! As you might imagine, it is chock full of changes to implement new statutory requirements and refine various parts of the payment system. All changes, unless otherwise noted, take effect on January 1, 2008.
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Laboratory and Pathology Claims: Top Denial Reasons from Trailblazer
January
2008
Duplicate claims' submissions are the number one reason for denials or rejections of laboratory and pathology claims, according to Trailblazer Health Enterprises, a Medicare contractor.
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2008 MPFS Final Rule Highlights Lab Changes: DOS for TC of Pathology and Reconsideration Process
December
2007
The 2008 final Medicare physician fee schedule (MPFS) includes two sections related to the clinical laboratory fee schedule. More details about the new policies can be found in the MFPS sections noted.
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Reconstruction of Computed Tomography: ACR Issues New Opinion on Initial Data Studies
November
2007
The American College of Radiology (ACR) recently published information about the reconstruction of computed tomography (CT) studies from initial data. Its previous opinion and new opinion are provided below. A follow-up question from MedLearn to the ACR is also provided as well as a response to it from an association representative. A brief analysis by one of the situation caused by the new ACR opinion concludes this article.
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Diagnostic Radiology Claims: Most Common Reasons for Denials - Learning from the Mistakes of Others
October
2007
Medicare contractor Trailblazer Health Enterprises recently issued a list of its top reasons for denying or rejecting diagnostic radiology claims between March and June 2007. Even if it isn't your payer, you may want to review this information with an eye toward your own history of denials, and take steps to ensure that you reduce them.
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