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CMS Publishes Proposed Rule for Hospice Wage Index Fiscal Year 2009
On May 1, CMS published a rule proposing the hospice wage index for fiscal year 2009, according to the Federal Register (73FR24000). This proposed rule also suggests phasing out the Medicare hospice budget neutrality adjustment factor and clarifies two wage index issues pertaining to the definition of rural and urban areas and to multi-campus hospital facilities. Comments are due by 5 p.m. ET on June 27. To read more, click here.
CMS Announces Rate Year 2009 Payment and Policy Changes for Long-Term Care Hospitals
CMS published the final regulation establishing rate year (RY) 2009 federal payment rates and policies for long-term care hospitals (LTCHs). The final payment rule for RY 2009 increases the standard federal rate for LTCHs by 2.7 percent from the 2008 rate. The final rule is posted here.
CMS Publishes Hospital Inpatient PPS Proposed Rule
CMS published the proposed rule regarding changes to the hospital inpatient prospective payment system (PPS) and fiscal year 2009 rates in the Federal Register (73FR23528). As part of this proposed rule, several additional hospital-acquired conditions (HACs) that would be subject to the HAC payment provision on October 1 are under consideration: surgical site infections following certain elective procedures, Legionnaires’ disease, glycemic control, iatrogenic pneumothorax, delirium, ventilator-associated pneumonia, deep vein thrombosis/pulmonary embolism, Staphylococcus aureus Septicemia, and Clostridium difficile-associated disease. The payment provision for the HACs that were selected through the fiscal year 2008 final rule will take effect on October 1. Due to new ICD-9-CM codes that will become effective October 1, CMS is proposing the removal of the CC/MCC designation for the existing pressure ulcer codes that identify site and the addition of the MCC designation to the new codes for stage III and IV pressure ulcers. This change would impact the HAC payment provision for pressure ulcers. Comments on the proposed rule are due to CMS by June 13. AHIMA will be preparing written comments. Access the proposed rule.
Long-sought Genetic Nondiscrimination Bill Passes Senate
On April 24, the Senate passed HR 493, the “Genetic Information Nondiscrimination Act” (GINA) by the unanimous vote of 95-0. Now, both Houses of Congress have overwhelmingly passed very similar versions of the GINA and AHIMA expects the bill to go to the President shortly.
AHIMA has spent more than a decade working unilaterally and with the Coalition for Genetic Fairness to pass a genetic nondiscrimination bill. In fact, GINA was a main focus of recent 2008 Hill Day activities.
Since the outset of our efforts on genetic nondiscrimination legislation in the 1990s, AHIMA’s membership has been with us through thick and thin to see this legislation enacted. GINA has been a part of AHIMA Hill Day efforts since their outset and have had countless letter-writing campaigns spanning back before the ease of the Advocacy Assistant.
Through the years, AHIMA have worked with many outstanding representatives and senators whose dogged determination on GINA has helped make its passage a reality. Representative Louise Slaughter (D-NY), who started this fight years ago, Rep. Judy Biggert (R-IL), Senators Edward M. Kennedy (D-MA), Olympia Snowe (R-ME), Susan Collins (R-ME), former Senator Tom Daschle, and countless others were integral to keeping GINA alive and moving it forward.
CMS Issues Final Rule for Standards for e-Prescribing
The Centers for Medicare and Medicaid Services (CMS) adopted the final rule on uniform standards for medication history, formulary and benefits, and fill status notification (RxFill) for the Medicare Part D electronic prescribing (e-prescribing) drug program (73FR18918). Additionally, CMS is adopting the National Provider Identifier (NPI) as a standard for identifying healthcare providers in e-prescribing transactions. It also finalizes the June 23, 2006, interim final rule with comment period that identified the National Council for Prescription Drug Programs (NCPDP) Prescriber/Pharmacist Interface SCRIPT standard, Implementation Guide, Version 8.1 as a backward compatible update of the NCPDP SCRIPT 5.0, until April 1, 2009. This final rule also retires NCPDP SCRIPT 5.0 and adopts the newer version, NCPDP SCRIPT 8.1, as the adopted standard.
Finally, CMS is implementing the compliance date of one year after the publication of these final uniform standards. These regulations are effective on June 6. For a copy of the final rule, click here.
CMS Expands PQRI Initiative
The Centers for Medicare and Medicaid Services (CMS) has expanded its 2008 Physician Quality Reporting Initiative (PQRI) to make it easier for healthcare organizations to participate. The program, which began in 2007, establishes a financial incentive for physicians and other healthcare practitioners to participate in a voluntary quality reporting program.
In addition to submitting PQRI measurement data as part of their Medicare claims submissions, the program enables participants to report to a medical registry, which ultimately will report the information to CMS. Additionally, participants can choose to report data on either individual measures or on groups of measures that capture a number of data elements. Further, the 2008 PQRI program will enable eligible professionals to begin reporting in July 2008 and still be eligible to earn incentive payments. View details about how to qualify for an incentive payment under this new option.
Inpatient PPS Proposed Rule on Display
The Centers for Medicare and Medicaid Services (CMS) has issued the hospital inpatient PPS proposed rule for fiscal year 2009 and it is expected to be published in the Federal Register on April 30. Several additional hospital-acquired conditions (HACs) that would be subject to the HAC payment provision on October 1 are being proposed. Under the HAC payment provision, CMS is proposing to pay the CC/MCC MS-DRGs only for those HACs coded as “Y” (yes, present on admission) and “W” (clinically undetermined) present on admission (POA) indicators. The CC/MCC MS-DRGs would not be paid for HACs coded as “N” (no, not present on admission) and “U” (unknown) POA indicators. CMS is considering whether payment should be made for HACs coded as a “U” POA indicator for certain discharge status codes. Comments on the proposed rule are due to CMS by June 13. Written comments from AHIMA will be forthcoming. To access the display copy of the proposed rule, Click Here. (Please note that this is a large file which may take a few moments to open.)
CMS Releases RAC Status Document for FY 2007
The Centers for Medicare and Medicaid (CMS) recently released a report that outlines the status on the use of recovery audit contractors (RACs) in the Medicare program for fiscal year 2007. In the report, CMS highlights improvements that will be made as it implements the permanent RAC program by 2010. Examples of improvements to the RAC program include a set limit on the number of medical records requested by the contractors. The RACs will be required to have certified coders and a medical director on staff for document review and discussion if requested, and they will be required to have a Web-based application to provide status of cases in the permanent program by 2010. Click Here to read report.
CMS Issues Corrections to Final Rule of OPPS,
CY 2008 Payment Rates
CMS issued corrections to the outpatient prospective payment system/ambulatory surgical center final rule with comment in the Federal Register on February 22. The final rule was published on November 27, 2007, and titled, “Changes to the Hospital Outpatient Prospective Payment System and CY 2008 Payment Rates, the Ambulatory Surgical Center Payment System and CY 2008 Payment Rates, the Hospital Inpatient Prospective Payment System and FY 2008 Payment Rates; and Payments for Graduate Medical Education for Affiliated Teaching Hospitals in Certain Emergency Situations Medicare and Medicaid Programs: Hospital Conditions of Participation; Necessary Provider Designations of Critical Access Hospitals.” The document included technical and typographical errors; for a listing and review of the corrections click here.
Updated 2008 Charges for Copying Medical Records
The Ohio Department of Health (ODH) has released the updated amounts hospitals can charge for copying medical records in 2008. Ohio Revised Code 3701.742 requires that ODH increase the amounts using the Consumer Price Index — a 2.8% increase from last year.
The following are amounts hospitals and companies can charge for copying medical records in 2008:
For requests made by patients or their representatives, hospitals may now charge
$2.74 per page for the first 10 pages,
57 cents per page for pages 11-50,
23 cents per page for pages numbering more than 50.
With respect to data recorded on something other than paper (e.g. X-rays, CDs), the new maximum charge is $1.87 per page.
CMS to Begin On-site Reviews for HIPAA Security Compliance
During a workshop sponsored by the National Institute of Standards and Technology (NIST), officials from the Centers for Medicare and Medicaid Services (CMS) indicated they will begin reviewing hospital compliance with HIPAA security in the next nine months. Until recently, CMS has primarily focused its efforts on outreach and education to promote compliance with HIPAA. Now, it will focus reviews of 10 to 20 hospitals, and the results will be published including lessons learned about data security issues. Before the reviews begin, CMS will post on its Web site a checklist of security practices and issues covered in the rules in order to prepare hospitals on what CMS will be looking for. The contractor CMS has hired to conduct the reviews will be interviewing the compliance officer, security director, lead systems security manager, and access controls manager at each hospital. Click Here for an overview of the HIPAA security standard.
CMS Increases Physician Fee Schedule Conversion Factor for First Half of 2008
The Medicare, Medicaid, and SCHIP Extension Act of 2007 made several changes affecting Centers for Medicare and Medicaid Services (CMS) payments to physicians. One such change provides for a 0.5 percent increase to the physician fee schedule conversion factor for dates of service beginning January 1 through June 30, instead of the -10.1 percent that was scheduled to take place. Click Here to view the updated formula.
AHIMA Posts Analysis of CY 2008 Hospital Outpatient PPS Final Rule
An analysis of the final rule addressing calendar year 2008 changes to the Medicare hospital outpatient prospective payment system (OPPS) has been posted on the AHIMA Web site. This analysis covers changes affecting packaged services, Ambulatory Payment Classification (APC) groups, hospital coding and payment for visits, payment for observation services, and quality data reporting. It also describes changes pertaining to non-OPPS topics that are addressed in this final rule, including an update of the revised Ambulatory Surgical Center (ASC) payment system, revisions to the hospital Conditions of Participation, and changes to the fiscal year 2008 hospital inpatient PPS payment rates. The final rule was published in the November 27 issue of the Federal Register. Click Here to read AHIMA's analysis.
POA Reporting for Claims Use Began January 1
Beginning October 1, 2007, the Deficit Reduction Act (DRA) required hospitals to identify secondary diagnoses that are present on admission (POA). The POA indicator is required for the principal and all secondary diagnoses in order to determine whether a selected condition developed during a hospital stay. Specific instructions on how to select and report the correct POA indicator are included in the “ICD-9-CM Official Guidelines for Coding and Reporting” and CMS Transmittal 1240. Click Here for more on POA and to read the Nov/Dec 2007 practice brief “Planning for Present on Admission”) Beginning January 1, hospitals that do not submit a valid POA code will receive a remark code on the remittance advice; however the claim will still be processed. Beginning April 1, claims that do not include a valid POA code for each diagnosis will be returned for completion. For additional resources, go to AHIMA's FORE Library: HIM Body of Knowledge and search for POA.
CMS Updates, Corrects HHA PPS Rule for 2008
The Centers for Medicare and Medicaid Services (CMS) published an update and corrections to the 2008 Home Health Agency (HHA) Prospective Payment System (72FR67656). These changes update the previous HHA-PPS rule published on August 29 (72FR49762). Some coding changes have been included in this correction. Details of this announcement can be found in the November 30 Federal Register by clicking here and looking under CMS.
Please note that AHIMA and the National Association for Home Care and Hospice have partnered to bring you the timely audio seminar, Home Health PPS Update on December 19. This seminar addresses the PPS changes effective January 1, 2008. Earn AHIMA CEUs and American Nurses Credentialing Center nursing contact hours. Click Here for more information.
CMS Issues 2008 Hospital Outpatient PPS Update
This week, the Centers for Medicare and Medicaid Services (CMS) officially released its 2008 interim and final rule for the Hospital Outpatient Prospective Payment System (PPS) (72FR66580). The rule includes updates to the Ambulatory Surgical Center Payment System (including specific HCPCS code updates), the Hospital Inpatient Prospective Payment System and FY 2008 payment rates, and Hospital Conditions of Participation for Necessary Provider Designations of Critical Access Hospitals. It retroactively revises the FY 2008 inpatient PPS rules, which applies the documentation and coding adjustment rates for the FY 2008 rates, including changes impacting Medicare-dependent small rural hospitals and sole community hospitals, previously announced and then changed by Congress in October. The interim portion of the rule applies to graduate medical education payments with comments due by January 28, 2008. The Hospital Outpatient PPS rule goes into effect January 1, 2008.
AHIMA will release an analysis of the final rule for the Hospital Outpatient PPS in the coming weeks, which will be highlighted in an upcoming e-Alert. Click Here for the November 27, 2007, Federal Register notice.
CMS Announces Rules and Requests for Physician and Part B Payment
The Centers for Medicare and Medicaid Services (CMS) has announced the final rule for physician payment and other Part B policies as well as for ambulance services and the amendment of the e-prescribing exemption for computer-generated fax transmissions. Included in the final rule are changes to physician payments, which, subject to potential Congressional reversal, will lower payments by some 10 percent. Other changes include refinements to resource-based practices, expenses, relative value units, requests for additions to the list of telehealth services, several coding issues including additional codes from the five-year review, final PQRI Quality Measures, revisions to the ambulance fee schedule, and amending the e-prescribing exemption for computer-generated fax transmissions to allow for fax use during network outages once the exemption is eliminated in 2009 (72FR66333). Comments will be accepted on the interim relative value units and on the self-referral requirements until December 31, 2007. Details on this announcement can be found in the November 27, 2007, Federal Register by Clicking Here.
CMS Adds Information on Reporting Hospital-Acquired Conditions
The Centers for Medicare and Medicaid Services (CMS) has added information on reporting and coding hospital-acquired conditions to its Web site. As of October 1, all inpatient prospective payment system hospitals have been required to submit present-on-admission indicator information for all primary and secondary diagnoses. On January 1, 2008, CMS will begin processing POA indicator data and will provide feedback to IPPS hospitals on reporting errors. From January 1 to March 31, 2008, hospitals will be educated on reporting errors and will not be subject to returned claims. As of April 1, 2008, claims that are submitted for payment that do not contain proper reporting of the POA indicator will be returned. Click Here to read the reporting requirements.
New Reporting Rules Published for Hospital Outpatient PPS
The Centers for Medicare and Medicaid Services (CMS) posted the final rule for the hospital outpatient prospective payment system. The final rule included details for implementation of this new outpatient reporting program. The selection of the outpatient measures was in part based on input from critical access hospitals that have been requesting transfer measures. The rule will not be published in the Federal Register until November 27, 2007, but it is available now on the CMS Web site by clicking here.
House Committee Passes NIST HIT Bill with AHIMA Language
The House Science and Technology Committee passed HR 2406 by voice vote on October 24. HR 2406 is a bill that authorizes the National Institute of Standards and Technology (NIST) to increase its efforts in support of the integration of the healthcare information enterprise in the United States. AHIMA has been working closely with the chairman on this legislation to insure that the bill properly recognizes the current standards development, adoption, and certification environment. AHIMA also provided draft language to the chairman to address the recommendations in the recent AHIMA/AMIA report, “Healthcare Terminologies and Classifications: Essential Keys to Interoperability.” Congressman Baron Hill (D-IN) offered the healthcare terminologies and classifications amendment that directs NIST to establish a task force to develop a strategic plan and develop recommendations for:
- the development, adoption and maintenance of terminologies and classifications
- gaining commitment of terminology and classification stakeholders to principles and guidelines for open and transparent processes to enable cost-effective interoperability and complete and accurate information
- the design of a centralized authority or governance model, including principles for its operation and funding scenarios
- US participation in the International Health Terminology and Standards Development Organization, and
- any other issues developed by the task force
The approved amendment names AHIMA and AMIA as industry groups to be members of the NIST task force. For additional information on this legislation, visit the Advocacy Action Center of the Advocacy Assistant.
HITSP Defines Healthcare Security,Privacy Standards
The Healthcare Information Technology Standards Panel (HITSP) has defined a set of standards and specifications that will help to keep patient medical information secure in an electronic environment. The standards will also help to assure that this information will only be used by authorized personnel for official purposes. The approved set of standards and specifications are available here. More information on HITSP is available by clicking here.
MS-DRGs a Go: Legislation Will Not Hold Up Implementation
The Centers for Medicare & Medicaid Services (CMS) final rule for the Medicare inpatient prospective payment system (IPPS) will become effective Monday, October 1, despite recent legislative action in Congress.
The CMS IPPS final notice (72FR47130) for FY 2008 was issued formally on August 22 and can be found by clicking here. Included in the changes for FY2008 for Medicare was the introduction and implementation of the new severity adjusted MS-DRG system.
Concerns regarding a reversal of this final notice first arose in July, when the US House of Representatives passed the Children's Health and Medicare Protection Act of 2007 (HR 3162 - CHAMP), which in part called for a delay in MS-DRG implementation. Recent compromise between the House CHAMP legislation and the Senate SCHIP bill removed all Medicare changes approved by the House. Therefore, no current legislation under discussion provides for any MS-DRG implementation freeze.
On September 26, the House passed new legislation, the TMA, Abstinence Education, and QI Programs Extension Act of 2007 (HR 3668). Included in this bill is a limitation on the amount of “behavioral adjustment” CMS can discount with regard to the implementation of MS-DRGs. HR 3668 has not moved to the US Senate for consideration and does not stop implementation of MS-DRGs. Should HR 3668 become law, the only change impacts reimbursement formulas, not the MS-DRG system.
Consultation with CMS indicates no changes in the scheduled implementation of MS-DRGs and other changes associated with the FY 2008 Medicare IPPS rule. Providers will be expected to bill claims under the new requirement as of October 1.
The new MS-DRG system consists of 745 new DRGs that will replace the current 538 CMS DRGs in both short-term and long-term acute care settings. In addition, short-term acute care hospitals will also be required to begin reporting the present on admission code on inpatient claims with discharges beginning October 1. To help you prepare for these changes, AHIMA has compiled an online list with links to timely resources and articles. To check out the full list of AHIMA resources, click here.
2008 ICD-9-CM Coding Guidelines Posted
The fiscal year 2008 ICD-9-CM Official Guidelines for Coding and Reporting, effective October 1, have been posted to the National Center for Health Statistics Web site. A conversion table for diagnostic and procedural code changes and addenda showing the changes for the ICD-9-CM index and tabular were also posted. To read the full ICD-9-CM Official Guidelines for Coding and Reporting, click here..
MS-DRGs Coming Soon
On August 22, the final rule for the acute care hospital inpatient prospective payment system was published. The rule implements the proposed severity adjusted MS-DRG system, which consists of 745 new DRGs that will replace the current 538 CMS DRGs. These changes will go into effect October 1. In addition, short-term, acute care hospitals will also be required to begin reporting the present on admission code on inpatient claims with discharges beginning October 1. To help you prepare for these changes, AHIMA has compiled an online list with links to timely resources and articles. To check out the full list of AHIMA resources, click here..
Maps between ICD-10-CM and ICD-9-CM Posted
The National Center for Health Statistics has posted general equivalence maps between ICD-10-CM and ICD-9-CM. Maps from ICD-10-CM to ICD-9-CM and ICD-9-CM to ICD-10-CM are provided. The new 2007 ICD-10-CM files available on the NCHS Web site include the ICD-10-CM preface, index, tabular, table of drugs and chemicals, and general equivalence mapping files. The mapping files provide a helpful link between the current ICD-9-CM codes and the new ICD-10-CM codes. A documentation and user's guide, which provides information needed to understand the structure and relationships in the mappings, is also available. For maps and the associated guides click here.
AHIC Use Cases Posted
The American Health Information Community (AHIC) has posted its prototype use cases and feed back instructions to its Web site. In January 2007, AHIC approved a recommendation to develop use cases that address certain aspects of public health case reporting, consultation and transfers of care, personalized healthcare, immunizations and response management, remote monitoring, and remote consultation. AHIC is a federally chartered advisory committee that provides input and recommendations to the Department of Health and Human Services on how to make health records digital and interoperable and ensure that the privacy and security of those records are protected, in a smooth, market-led way. For prototype use cases and feedback instructions click here.
CMS Proposes New Rules for Ambulatory Surgery Centers
The Centers for Medicare & Medicaid Services (CMS) announced the proposed rule for ambulatory surgery centers. Click here for more information about the proposed rule as well as the final payment methodology rule and the proposed payment rule for calendar year 2008. Public comments will be accepted until October 30 and a final rule will be issued later this year.
CMS Publishes Hospital Inpatient PPS Final Rule
The Centers for Medicare & Medicaid Services (CMS) published the final rule regarding changes to the hospital inpatient prospective payment system and fiscal year 2008 rates in the August 22 Federal Register. Provisions of this final rule include the implementation of MS-DRGs on October 1 and the list of hospital-acquired conditions that will not trigger a higher-weighted MS-DRG assignment when they develop after admission, effective October 1, 2008. AHIMA will be posting a summary of the major revisions of the final rule on the Policy and Government Relations page of the AHIMA Web site in September. The final rule can be found by clicking here.
CMS Publishes Final Rule on
Severity-adjusted DRGs
The Center for Medicare & Medicaid Services (CMS) issued a final rule for inpatient hospital services in fiscal 2008 that would increase total Medicare reimbursement by an estimated 3.5 percent and include new severity-adjusted DRGs to more accurately account for patient severity. The 745 new Medicare Severity DRGs (MS-DRGs) will replace the current 538 DRGs. Medicare payment is expected to increase for hospitals serving more severely ill patients and decrease for those serving patients who are less ill. The MS-DRGs will be phased in over two years beginning October 1. For more information, Click Here.
Medicare POA Reporting Limited to Short-term, Acute Care Hospitals
The Centers for Medicare and Medicaid Services (CMS) issued instructions for present on admission (POA) reporting on Medicare claims. For Medicare, POA reporting is only required for inpatient admissions to short-term, acute care hospitals. Critical access hospitals, Maryland waiver hospitals, cancer hospitals, and children's inpatient facilities are exempt from this requirement. Also, Medicare does not require POA information to be reported for admissions to facilities that are not short-term, acute care hospitals, including long-term care hospitals, psychiatric facilities, and rehabilitation hospitals. Although the Medicare requirement is limited to inpatient admissions to short-term, acute care hospitals, some states may require POA reporting for other types of facilities. To read CMS's transmittal on Medicare requirements for POA reporting, click here.
CMS Releases Prospective Payment System Proposed Rules
The Centers for Medicare and Medicaid Services (CMS) published the proposed payment and policy updates to the Inpatient Prospective Payment System (PPS), Inpatient Rehabilitation Facility PPS, Home Health PPS, Skilled Nursing Facility PPS, and Inpatient Psychiatric Facility PPS in the May 3 Federal Register. Click here for more information. For the latest information from CMS on these proposed changes, click here.
Publication of Inpatient PPS Proposed Rule Expected Soon
The text of the hospital inpatient PPS proposed rule for fiscal year 2008 is expected to be published in the Federal Register. As noted in the April 18 e-alert, the proposed rule would create 745 new severity-adjusted DRGs (Medicare Severity DRGs or MS-DRGs) to replace the current 538 DRGs on October 1, 2007. The rule also identifies six conditions that, starting in fiscal year 2009, would not trigger a higher DRG unless they were present on admission. Five new quality measures are also being proposed. The Centers for Medicare and Medicaid Services (CMS) will accept comments on the proposed rule until June 12. AHIMA will be preparing written comments. To read a preview of the proposed rule, click here.
AHIMA will prepare members for these changes in several ways:
* A joint AHIMA/AHA audio seminar on May 24 will provide an overview of the changes in the proposed rule (find out more information about this audio seminar in story #15, below).
An audio seminar on June 28 will help coding professionals understand the implications of the proposed MS-DRGs.
An additional audio seminar discussing the final rule will take place in August or September.
Coding Regional Meetings during this spring and summer will include a session on using ICD-9-CM to measure patient severity of illness. (Click here for more information including dates and locations of these meetings.)
Continued coverage in e-alert and the Journal of AHIMA.
A new book on severity-adjusted DRGs will be available fall 2007. We are also compiling existing articles and publications on case mix and severity-adjusted DRGs to help members learn more on these topics. Look for this Smartpack by June 1.
Revised editions of our publications addressing the DRG system as well as additional opportunities for education and training will be available shortly after CMS releases a final rule.
Genetic Nondiscrimination Bill Easily Passes House
The Genetic Information Nondiscrimination Act (HR 493) easily passed the US House of Representatives on April 27 by a vote of 420-3. The action now moves to the Senate where the Senate Health, Education, Labor, and Pensions (HELP) Committee approved its version of the legislation, S. 358, on January 31, 2007, by a vote of 19-2. Senator Tom Coburn (R-OK) has placed a hold on the legislation in order to work out some concerns with Senator Edward M. Kennedy (D-MA), chair of the Senate HELP Committee. The president is expected to sign the legislation once it is forwarded from Congress. For further information on the legislation’s specifics, and tovisit the Action Center of the Advocacy Assistant, click here. AHIMA strongly supports this legislation, and it was one of our primary advocacy issues during AHIMA's 2007 Hill Day.
CMS Proposes Payment Reforms for Inpatient Hospital Services in 2008
The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that takes significant steps to improve the accuracy of Medicare’s payment under the acute care hospital inpatient prospective payment system (IPPS) while providing additional incentives for hospitals to engage in quality improvement efforts. Expanding on the work of the previous two years, the proposed rule would create 745 new severity-adjusted diagnosis related groups (DRGs) (Medicare Severity DRGs or MS-DRGs) to replace the current 538 DRGs. To view the complete proposed rule, click here.
House Returns with Genetic Nondiscrimination on the Horizon
The House of Representatives returned from spring break the week of 4/16 with HR 493, the Genetic Information Nondiscrimination Act (GINA), which is almost ready for floor consideration. The House Education and Labor Committee, the House Ways and Means Committee, and the House Energy and Commerce Committee all passed GINA with ease. It is now up to the House Rules Committee to iron out the minor differences in each bill passed by the three committees. Once this is complete, the bill will proceed to the House floor. For additional information on GINA, visit AHIMA’s Advocacy Assistant.
National Provider Identifier Update
The national provider Identifier (NPI) implementation date is scheduled for May 23. If you are a healthcare provider who bills for services, and if you bill Medicare for services, you need an NPI. Getting an NPI is free and easy. Once you obtain your NPI, it is estimated that it will take 120 days to do the remaining work to use it. Physicians and providers should be applying for their new NPI number, which will replace any identification number currently being used. Once the NPI is obtained, it can be used for billing testing prior to the implementation date and will be required for use on all claims submitted after that date. For information on the NPI, visit the Centers for Medicare and Medicaid Services Web site by clicking here. Physicians can apply for their new NPI online, thus speeding up the approval process. At this time, CMS estimates only 60 percent of physicians and providers have obtained their NPI.
Are You Ready for the Revised CMS-1500 Claim Form?
The deadline for submitting claims using the new CMS-1500 (08/05) claim form is April 2. This new claim form will replace the outdated form (12/90). The new claim form has been revised to create spaces for the new national provider identifier (NPI) number as well as other minor changes. All health plans, clearinghouses, and other support vendors should be ready to accept claims on the revised form by that date. For physicians, the first step is to obtain a new NPI number and then test the new claims form with the NPI. Click here for the change log. The instructions for the revised form can be found here.
 Click here for Archived Updates.
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