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OPPS – April 2012 Update

From: CMS Transmittal 2418 (Medicare Claims Processing) – 3/2/12

Transmittal Summary of Changes

 This Recurring Update Notification describes changes to and billing instructions for various payment policies implemented in the April 2012 OPPS update. The April 2012 Integrated Outpatient Code Editor (I/OCE) and OPPS Pricer will reflect the Healthcare Common Procedure Coding System (HCPCS), Ambulatory Payment Classification (APC), HCPCS Modifier, and Revenue Code additions, changes, and deletions identified in this Change Request (CR).

Health Reform Law Provides Coverage for Nearly 50K Americans with Pre-Existing Conditions

From: HHS News Release – 2/23/12

News Release Excerpt:

Health and Human Services Secretary Kathleen Sebelius today announced that the new health care law’s Pre-Existing Condition Insurance Plan (PCIP) program is providing insurance to nearly 50,000 people with high-risk pre-existing conditions nationwide. The Department released a new report demonstrating how PCIP is helping to fill a void in the insurance market for consumers with pre-existing conditions who are denied insurance coverage and are ineligible for Medicare or Medicaid coverage.

“For too long, Americans with pre-existing conditions were locked out of the health care system and their health suffered,” said HHS Secretary Kathleen Sebelius. “Thanks to health reform, our most vulnerable Americans across the country have the care they need.”

Under the Affordable Care Act, in 2014, insurers will be prohibited from denying coverage to any American with a pre-existing condition. Until then, the PCIP program will continue to provide enrollees with affordable insurance coverage.

Read more…

HHS Secretary Kathleen Sebelius Announces Major Progress in Doctors, Hospital Use of HIT

From: HHS News Release – 2/17/12

News Release Excerpt:

Kansas City, MO – Today, U.S. Department of Health and Human Services’ Secretary Kathleen Sebelius announced the number of hospitals using health information technology (IT) has more than doubled in the last two years.  She also announced new data showing nearly 2,000 hospitals and more than 41,000 doctors have received $3.1 billion in incentive payments for ensuring meaningful use of health IT, particularly certified Electronic Health Records (EHR). 

Critical Access Hospital Fact Sheet

From MLN Matters – Updated January 2012

The MLN Matters fact sheet for Critical Access Hospitals was updated in January 2012.  These fact sheets provide very useful overview information concerning the numerous Medicare program payment systems.

From: MLN Matters MM7737 – 1/26/12

This article is based on Change Request 7737 that informs you that new Medicare Physician Fee Schedule (MPFS) payment files have been created and are available to Medicare contractors.

From: CMS Transmittal 2395 (Pub 100-04) – 1/26/12

Summary of Changes

This instruction implements the Multiple Payment Reduction (MPPR) for physician services for certain diagnostic imaging procedures in CAHs.

From: CMS Transmittal 2393 (Pub 100-04) – 1/25/12

Summary of Changes

The purpose of this Change Request (CR) is to provide IRF hospitals updated instructions on submission of “no-pay” bills to Medicare for Medicare Advantage (MA) patients.

From: CMS Transmittal 1017 (Pub 100-20) – 1/24/12

Summary of Changes

This transmittal replaces Transmittal 1014 dated January 6, 2012 to correct  the effective date of the implementation of this ruling.  The corrected effective date is January 30, 2012.  The transmittal involves instructions to contractors to inform teaching hospitals of the proper way to report the FICA refund for medical residents on the Medicare cost report.

From: CMS Transmittal 2388 (Pub 100-04) – 1/20/12

Summary of Changes

CMS is clarifying  billing instructions to Pub 100-04, Medicare Claims Processing Manual, Chapter 3, Inpatient Hospital Billing, Section 40, Billing Coverage and Utilization Rules for PPS and Non-PPS Hospitals when life time reserve (LTR) days exhaust during the nonoutlier portion of an Inpatient Prospective Payment System (IPPS) stay.

From: CMS Transmittal 2379 (Pub 100-04)- 1/18/12

CMS Summary of Changes

This Change Request (CR) provides a summary of the policies in the CY 2012 Medicare Physician Fee Schedule Final Rule and announces the Telehealth Originating Site Facility Fee payment amount for CY 2012. The attached Recurring Update Notification applies to Publication 100-04, Chapter 12, Section 190.6 and Publication 100-02, Chapter 15, Section 270.5

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