Medicare Contractors to Hold ’11 Home Dialysis Claims
Year 2011 end stage renal disease (ESRD) home dialysis claims for continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD) are being held and will not be...
View ArticleDressings Not Separately Payable Under ESRD PPS
All dressings and protective catheter coverings are included in the End-Stage Renal Disease Prospective Payment System (ESRD PPS) bundled payment amount, effective. Jan. 1. Dressings or protective...
View ArticleMedPAC Recommends Physician Pay Increase for 2012
If Congress takes up recent recommendations made by the Medicare Payment Advisory Commission (MedPAC), acute care and outpatient hospitals, physicians and other health professionals, ambulatory...
View ArticleCMS Proposes 2012 Payment Policy and Rate Changes
The Centers for Medicare & Medicaid Services (CMS) ran a triple play on July 1, issuing proposed rules that will affect physicians, hospital outpatient departments (HOPD), ambulatory surgical...
View ArticleOrgan Disease Panels Paid Under Clinical Lab Fee Schedule
The Centers for Medicare & Medicaid Services (CMS) is updating requirements regarding independent laboratory billing. The policy update applies to automated multi-channel chemistry (AMCC) organ...
View ArticleCMS Clarifies ESRD-related Services Monthly Capitation
Effective Jan. 1, 2011, Medicare contractors will pay for home dialysis monthly capitation payment (MCP) services even when a qualified practitioner other than the MCP physician or practitioner...
View ArticleNew ESRD Quality Initiative Program Is Launched
The Centers for Medicare & Medicaid Services (CMS) has launched a new quality initiative for Medicare-certified renal dialysis facilities. The End-Stage Renal Disease (ESRD) Quality Incentive...
View ArticleBilling Monthly ESRD Codes
Providers who submit claims for monthly end stage renal disease (ESRD) services (e.g., CPT® codes 90951 through 90966) should be aware of how to complete the Days/Units and Dates of Service (DOS)...
View ArticleFilter Out Bad ESRD Coding
Use severity, condition, classification, and sequencing to help clean up your claims. By Michelle A. Green, MPS, RHIA, CPC, FAHIMA End stage renal disease (ESRD) is the most severe form of chronic...
View ArticleESRD PPS Rates, Other Items Change for 2012
The Centers for Medicare & Medicaid Services (CMS) is implementing new rates for payment, changes to the outlier policy, and consolidated billing requirements. The extensive announcement, Change...
View Article2012 OPPS: Hospitals See Payment Ups and Downs
Overall CMS estimates an increase with an emphasis on quality reporting. By Denise Williams, RN, CPC-H In the 2012 Outpatient Prospective Payment System (OPPS) final rule, the Centers for Medicare...
View ArticleHospitals: Set a Course for Compliance
Use the 2012 OIG Work Plan to chart your hospital’s compliance plan. By Jillian Harrington, MHA, CPC, CPC-P, CPC-I, CCS-P Last month, we explained the U.S. Department of Health & Human Services...
View ArticleMedicare Puts J3370 Claims on Hold
Wondering why your claims for Vancomycin® injections aren’t being paid? According to a notice posted on TrailBlazer Health Enterprise’s website, the Centers for Medicare & Medicaid Services (CMS)...
View ArticleCMS Proposes Payment Policies and Rates for 2013
In rapid fire succession, the Centers for Medicare & Medicaid Services (CMS) released proposed rules in July that will dictate payment policies and reimbursement rates for health care providers in...
View ArticleGov’t Shutdown Delays Some Federal Files and Rules
Some federal rules and files essential to practice management and the revenue stream are delayed this year, thanks to the nearly three-week government shutdown, last month. The Centers for Medicare...
View ArticleSequence ESRD Diagnoses with Care
Patients with end stage renal disease (ESRD), and other stages of chronic kidney disease (CKD), often also suffer from conditions such as hypertension, diabetes mellitus, anemia, and transplant...
View ArticleWhat it Takes to Get Medicare to Pay for Ambulance Transports
Ensuring coverage of ambulance services for your end-stage renal dialysis (ESRD) patients requires diligence. Dialysis facility ambulance transports often do no meet medical necessity criteria, as...
View ArticleKidney Transplant Dx. Coding
By: Gouri Pathare MBBS, CPC Kidney transplantation is a treatment option for most patients with End Stage Renal Disease (ESRD). The procedure may be deceased-donor (cadaveric) or living-donor...
View ArticleCMS Puts ESRD Home Dialysis Policy in Writing
The Centers for Medicare & Medicaid Services (CMS) has added language to its billing guidelines for home dialysis (less than full month) to be consistent with its policy for partial-month,...
View ArticleCMS Releases Final Rules for 2016 Payment
The Centers for Medicare & Medicaid Services (CMS) issued final rules detailing how the agency will pay for services provided to beneficiaries in Medicare by physicians and other healthcare...
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