This week’s updates include: Claims processing Medicare Secondary Payer (MSP) policy and procedures regarding ongoing responsibility for medicals (ORM); Maintenance and update of the temporary hook created to hold OPPS claims that include certain drug HCPCS codes; and more!
While implementation of the long awaited and long overdue ICD-10 coding system is just around the corner, some questions still remain regarding “split billing” based on the October 1, 2015, date of service. Lately, I have been asked questions by billing staff from both PPS and critical access hospitals (CAH) so this may be a good time to clarify how and when to split bill.
A few days after Briefings on APCs conducted the interview that appeared in last month's issue with W. Jeff Terry, MD, an AMA delegate from Mobile, Alabama, the AMA and CMS announced an accord regarding ICD-10.
In a joint announcement, the organizations said that CMS would not audit or deny Part B physician fee schedule claims for one year after ICD-10-CM implementation due to lack of specificity. While physicians will still be responsible for meeting medical necessity and LCD and NCD requirements, valid ICD-10-CM codes that include the appropriate first three characters will be sufficiently specific for Medicare claims.
As the industry approaches ICD-10 implementation, end-to-end testing becomes more critical. Testing allows organizations to determine the efficacy of their preparations. It also answers critical questions for ICD-10 stakeholders: Can applications accommodate ICD-10 codes correctly? Does data flow seamlessly between internal and external interfaces? Are payers able to receive, adjudicate, and pay claims correctly?
While some HIM professionals may feel a sense of relief knowing RAC audits are on hold for the remainder of 2015, that should not deter workforce members from keeping track of denials and appeals and defending code assignments.
It's been two years since the American Health Information Management Association (AHIMA) joined ACDIS to offer the industry physician query instructions in Guidelines for Achieving a Compliant Query Practice, published in February 2013.
