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Connecticut hospital pays $471,000 to settle false claims allegations stemming from failure to refund overpayment the hospital identified
(12/8/2011)
Read about this false claims case in which the hospital failed to report its own audit findings regarding incorrect billing to the government.
OIG releases compliance podcasts
(12/7/2011)
The Office of Inspector General (OIG) of the Department of Health and Human Services has released the first of 11 short video and audio presentations aimed at health care providers covering what OIG views as "top health care compliance topics."
Timely Filing Limitation, 12/31/2010
(12/23/2010)
REMINDER – Medicare Fee for Service claims with a date of service from October 1, 2009 through December 31, 2009 must be filed by December 31, 2010.
3-Day Payment Window Clarification
(11/10/2010)
Change Request 7142 of October 29, 2010 gives additional information to providers when services have been provided that are unrelated to the inpatient stay.
OIG Issues 2011 Work Plan
(11/8/2010)
On October 7, 2010 the Department of Health and Human Services, Office of Inspector General (OIG) posted its 2011 Work Plan.
Reporting Visits with Value Codes 50-53 Deleted
(10/13/2010)
Discussion of the removal of the reporting requirement of total number of therapy visits using codes 50-53.
Observation Services
(9/24/2010)
In an article posted to the National Government Services (NGS) website, it has been noted that there is a trend for billing outpatient observation services greater than 48 hours.
UPDATE: Date of Outpatient Procedure Within Three Day Rule
(9/20/2010)
Update to recent email alert discussing the three day rule.
Date of Outpatient Procedure Within Three Day Rule
(9/13/2010)
When an outpatient procedure is performed within 3 days prior to the inpatient stay, the procedure should be listed on the claim; CMS will bundle the procedure into the MS-DRG payment.
Payment Adjustments for Conditions Acquired in Hospitals
(7/22/2010)
Bulletin discussing payment adjustments for inpatient hospitals with high volumes of "hospital acquired conditions."
Maximum Period for Medicare Claims Submission Reduced
(7/20/2010)
Section 6404 of the Patient Protection and Affordable Care Act reduces the maximum allowed time period for submission of Medicare Part A and Part B claims to one calendar year from the date of service.
CMS Answers Q&A Regarding Physician Supervision
(6/2/2010)
CMS answers common questions about physician supervision requirements.
New Enforcement Changes with Health Care Reform
(6/2/2010)
Bricker & Eckler bulletin highlighting new enforcement authorities that the federal government now has of which health care providers will want to take note.
Timely Filing Limitations for Medicare Have Changed!
(4/27/2010)
As part of the Patient Protection and Affordable Care Act (PPACA) signed into law on March 23, 2010 the time period for filing claims timely has changed.
Medically Unlikely Edits (MUE)
(4/9/2010)
Transmittal 652, Change Request 6712, dated March 17, 2010 addresses Medically Unlikely Edits (MUE).
Bundling Non-Diagnostic Service
(3/24/2010)
Recently there has been much publicity regarding the bundling of non-diagnostic services by hospitals. Ohio hospitals received information on this from the Ohio Hospital Association and information has been printed in various publications on this issue.
Rehabilitation Changes as of January 2010
(12/21/2009)
Chapter 32 of the Medicare Claims Processing Manual have been revised effective January 4, 2010 to reflect the final OPPS rules for Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services and Pulmonary Rehabilitation Services.
Is the Third Time the Charm? CMS Finalizes Supervision Requirements for Outpatient Hospital Services
(11/20/2009)
Bricker & Eckler Health Care Bulletin on newly released CMS guidance, effective January 1, 2010, modifying the physician supervision requirements for hospital outpatient therapeutic and diagnostic services.
Outpatient Physical Therapy and Occupational Therapy Claim Review by NGS
(9/15/2009)
NGS will begin editing claims based on the current Outpatient Physical Therapy and Occupational Therapy Local Coverage Determination (LCD)
Lipid Profile/Cholesterol Testing
(7/15/2009)
According to National Government Services (NGS) providers have been inappropriately billing a Lipid Panel (CPT code 80061) and a Lipoprotein (CPT code 83721) test for the same patient on the same date of service.
Physician Orders for an Electronic Ordering System
(7/6/2009)
Information regarding "proof of a physican order" for providers who use an electronic ordering system.
CMS Publishes New Modifiers for Outpatient Never Events, Clarifies Hospital Acquired Conditions
(6/19/2009)
Recently, CMS has introduced three new modifiers for use with never events identified by the National Quality Forum (NQF).
New HCPSCS Code: C9899 (Implanted Prosthetic Device, Payable Only for Inpatients Who Do Not Have Inpatient Coverage)
(2/11/2009)
New HCPCS code C9899 (implanted prosthetic device, payable only for inpatients who do not have inpatient coverage) was effective for services furnished on or after January 1, 2009.
Recovery Audit Contractors (RAC)
(2/3/2009)
The RAC program mandated by the Tax Relief and Health Care Act of 2006 will roll-out nationwide no later than January 1, 2010. It is anticipated that Ohio will be one of the last states in Region B to "roll-out" the program.
CMS Quietly 'Clarifies' Rule Related to Physician Supervision of On-Campus Hospital Outpatient Department Therapeutic Services
(1/30/2009)
Bricker & Eckler Health Care Bulletin describing new changes regarding physician supervision for therapeutic services.
2009 New/Established Patient
(1/23/2009)
Bulletin defining new and established patient defined according to 2009 Final OPPS Rule.
2009 Drug Administration Codes
(1/12/2009)
New drug administration CPT codes effective January 1, 2009.
Medicare Administrative Contractor (MAC) Selected for Ohio
(1/8/2009)
Medicare Administrative Contractor (MAC) Selected for Ohio
Modifier -25
(10/23/2008)
An article was recently published to the National Government Services (NGS) website that should serve as a reminder for billing a visit code with modifier -25.
OIG Issues 2009 Work Plan
(10/7/2008)
Alert discussing OIG's 2009 Work Plan.
Medicare Publishes Medically Unlikely Edits
(10/3/2008)
CMS announced that effective October 1, 2008, most of the medically unlikely edits (MUEs) will be published.
October 2008 Update of OPPS
(9/24/2008)
The October 2008 Update of the Hospital Outpatient Prospective Payment System was released on September 19, 2008, Transmittal 1599
Revised Advanced Beneficiary Notice Form
(8/27/2008)
Discussion of revised ABN form.
Coding Compliance Newsletter - August 2008
(8/18/2008)
Newsletter summarizing the 2009 OPPS proposed rule.
Medicare OPPS Proposed Rule for 2009
(7/14/2008)
On July 3, CMS published on its website the Outpatient Prospective Payment System (OPPS) proposed rule for 2009. It is to be published in the Federal Register on July 18.
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