CMS Seeking OASIS Change Comments

The Centers for Medicare & Medicaid Services (CMS) issued a notice announcing proposed changes to the Outcome and Assessment Information Set (OASIS) in the June 21 Federal Register. The proposed version reflects changes to accommodate ICD-10-CM coding set which go into effect October 1, 2014.

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Preparing For ICD-10: The Role Of Clearinghouses

Practices preparing for the October 1, 2014, ICD-10 deadline are looking for resources and organizations that can help them make a smooth transition. It is important to know that while clearinghouses can help, they cannot provide the same level of support for the ICD-10 transition as they did for the Version 5010 upgrade. ICD-10 describes a medical diagnosis or hospital inpatient procedure and must be selected by the provider or a resource designated by the provider as their coder, and is based on clinical documentation.

During the change from Version 4010 to Version 5010, clearinghouses provided support to many providers by converting claims from Version 4010 to Version 5010 format. For ICD-10, clearinghouses can help by:

  • Identifying problems that lead to claims being rejected
  • Providing guidance about how to fix a rejected claim (e.g., the provider needs to include more or different data)

Clearinghouses cannot, however, help you identify which ICD-10 codes to use unless they offer coding services. Because ICD-10 codes are more specific, and one ICD-9 code may have several corresponding ICD-10 codes, selecting the appropriate ICD-10 code requires medical knowledge and familiarity with the specific clinical event.

While some clearinghouses may offer third-party billing/coding services, many do not. And even third-party billers cannot translate ICD-9 to ICD-10 codes unless they also have the detailed clinical documentation required to select the correct ICD-10 code.

As you prepare for the October 1, 2014, ICD-10 deadline, clearinghouses are a good resource for testing that your ICD-10 claims can be processed—and for identifying and helping to remedy any problems with your test ICD-10 claims.

Impact Of DOMA Ruling On Healthcare

The  decision by the U.S. Supreme Court to strike down the Defense of Marriage Act (DOMA) is expected to have a major impact on health coverage and other benefits for legally married same-sex partners of federal employees and members of the military, as well as on tax treatment for private health coverage.

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CT Launches Insurance Exchange Marketing Campaign

Earlier this week, organizers of Connecticut’s state health insurance exchange outlined a $15 million marketing campaign designed to inform residents of their options before the virtual marketplace opens for enrollment in October. The goal is to reach at least 100,000 of the state’s 344,000 uninsured residents.

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OIG To CMS: Stop Improper Part D Prescribing

According to a recently released report by the Office of Inspector General (OIG), more than 700 general-care physicians wrote potentially dangerous and unnecessary prescriptions for elderly and disabled patients in 2009. As a result, the OIG has asked the Centers for Medicare & Medicaid Services (CMS) to take a series of actions to stop inappropriate Part D prescribing.

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Final Regulation Regarding SNF Hospice Contracts Released

HMS Healthcare Management Solutions has learned the final regulation requiring nursing facilities and skilled nursing facilities to have contracts with hospices (mirroring the requirement in the 2008 Hospice Conditions of Participation) has been released.  It is set for publication in the Federal Register tomorrow and will be effective 60 days from publication.

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