ICD 10 IMPLEMENTATION DEADLINE COULD BE PUSHED BACK
CMS is considering pushing back the October 1, 2013 deadline for providers to start using the new diagnostic codes known as ICD-10 due to complaints from medical groups. According to AMA the cost to convert to ICD-10 could range from $83,000 to more than $2.7 million depending on the size of the practice. Although not everyone agrees and are pushing forward to leave the deadline of October 1, 2013.
posted 2/15/12
2012 MEDICARE PAYMENT RATES
In accordance with the funding formula that was established by the Balanced Budget Act of 1997, starting in 2012 physicians will face a slightly smaller cut to their Medicare payments. A cut of 29.5% was expected however the cut came in at 27.4%.
To view all the changes visit: https://www.cms.gov
posted 11/2/11
ICD 10 UPDATE - IS YOUR FUTURE AT RISK?
With less than two years until the implementation of ICD-10, many organizations are still unprepared. According to a recent survey conducted by HealthLeaders Intelligence, many have not even completed the initial readiness assessment, citing funding or manpower as the main reasons.
Once implemented, some hospital organizations are expecting to see a reduction in revenue as much as 20% based on unbundling and like diagnosis and procedures. However, some do eventually see the change will pay for itself within two years, while others don't expect to see any return on investment and over a quarter of those surveyed are unsure.
One thing that you can be sure of according to the people in Washington, the date is not moving so make sure your organization is prepared.
posted July 26, 2011
CMS RELEASES 2012 PROPOSED PAYMENT CHANGES
Centers for Medicare & Medicaid Services (CMS) have released the 2012 Medicare Physician Fee Schedule. There is a proposed cut to Medicare physician payments of 29.5%. The American Society of Anesthesiologists is currently reviewing the proposed rule to discover the effect to anesthesia payments.
posted July 7, 2011
OIG RECOVERIES COULD EXCEED $3 BILLION
For the first half of the 2011 fiscal year the OIG expects to recover $3.2 billion dollars which comes from 349 criminal and 197 civil actions. There is an additional $222 million from audits, there has been 883 individual and entities exclusions from federal healthcare programs.
posted June 9. 2011
PROPOSED CHANGE TO HIPAA RULE
In an effort to promote accountability throughout the health care system this proposed rule would give people the right to get a report on who has electronically accessed protected health information. This information would be provided by person requesting an access report. OCR Director Gerogina Verdugo, states, "this proposed rule represents an important step in our continued efforts to promote accountability across the health care system, ensuring that providers properly safeguard private health information".
posted June 3, 2011
NATIONAL TESTING DAY FOR VERSION 5010 SET
Additional Day added for testing
August 24, 2011 has now been added as a testing day
Wednesday June 15, 2011 has been set a national testing day to make sure that all HIPAA covered entities are ready for the January 1, 2012 deadline. The testing day will serve as an opportunity for providers, clearinghouses and other vendors to test their compliance efforts, with the benefit of real-time help desk support.
AMA Correction
The American Medical Association has issued a correction to the question and answers that appeared in the November 2010 CPT Assistant regarding "Fluoroscopy"
The correction is as follows: "for certain spinal procedures, fluoroscopy is NOT considered inclusive of the procedure (eg 62267, 622701-62282, 62310-62319 and is indeed separately reportable, when performed".
"Injection of contrast during fluoroscopic guidance and localization is an inclusive component of 62263, 62264, 62267, 62270-62273, 62280-62282, 62310-62319. Fluoroscopic guidance and localization is reported with 77003, unless a formal contrast study is performed, in which case the use of fluoroscopy is included in the supervision and interpretation codes".
"However, certain spine injection and therapeutic spine procedures do include fluoroscopy for which code 77003 is not additionally reported. These codes include the percutaneous lysis of adhesion codes 62263 and 62264, the removal/revision of peripheral neurostimulator codes 63661-63664, the transforaminal epidural injection codes 64479-64483, and the paravertebral facet joint codes 64490-64495".
Code 77003 identifies the fluoroscopic guidance to assist in accurately localizing specific spinal anatomy for placement of a needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural, subarachnoid or sacroiliac joint) including neurolytic agent destruction. Therefore, code 77003 is reported in conjunction with code 62267, 62270-62273, 62280-62282 and 62310-32319, when fluoroscopic guidance is necessary and performed with these injections, drainage or aspiration procedures".
posted January 12, 2010
Clarification on Red Flag Rule
A new measure went into effect on December 18th, 2010 as a result of continued confusion over which businesses were required to implement an Identify Theft Prevention Program in accordance to the Red Flag Rules.
This new amendment limits the definition of creditor to those who in the course of business "regularly and ordinarily" 1) obtain or use consumer reports, 2) furnish information to consumer reporting agencies in the course of a credit transaction, or 3) advance funds on behalf of person, based on obligation to repay.
What this means is that entities who allow deferred payment for a service are exempt form the Red Flag Rules, unless described in the one of the previous practice.
For all entities it would still be a smart decision to implement an identify theft policy whether covered by the Red Flag Rules or not.
posted January 7, 2011
Red Flag Update
On December 7 the House passed the Senate legislation that will exempt physicians from the identity theft regulations, more commonly known as Red Flag Rules", which has been critiqued as an unnecessary burden by organized medicine. This legislation waits for President Obama signature and averts the enforcement of the regulations that would be in effect January 1, 2011.
posted December 8, 2011
Stricter definition could cut payment
Start working with your payors now to avoid a cut of $30 to $150 per procedure in 2011 due to a revised definition of transforaminal epidural injections. Imaging guidance (fluoroscopy) was added to the transforaminal injections definition in CPT 2011. You cannot report or receive payment on 77003 next year.
According to Devona Slater, the 2011 Physician Fee Schedule didn't roll Relative Value Units for 77003 into the RVUs for the transforaminal injections.
posted December 7, 2011
Deadline Extended...
On November 18th the Senate gave a short term reprieve that delays a 23% Medicare cut that was to take effect on December 1st. The house is not expected to take action until after the Thanksgiving Holiday.
House leaders presented legislation which would provide a 1% update and extend Medicare payment for 13 months.
The American Medical Association is hoping that when Congress reconvenes they pass a a more suitable fix to the situation stating this will inject stability to the Medicare program for both patients and physicians.