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April 2016 Client Newsletter

Medicare 60 Day Refund Final Rule
CMS issued its final rule describing the responsibilities providers have to report and return Medicare Part A and B overpayments in cases where they are self-identified. These standards are intended to provide clarity and consistency among the requirements for reporting and refunding these overpayments. This rule became effective on March 14, 2016.
Under the final rule, providers must report and return overpayments by 60 days after the date on which the overpayment was identified or should reasonably have been identified. The final rule also establishes a look back period of six years from the date the overpayment was received for which these requirements apply. The proposed rule originally included a ten year look back period.
Cape Medical Billing clients are light-years ahead of this issue. CMB has actively identified overpayments for many years and notified clients monthly.
 As announced in December, Noridian Healthcare Solutions was awarded the DME contract effective July 1, 2016. We are monitoring the changes for any affected clients and will handle any necessary paperwork.
Audits & Appeals for Global Period Services
Whenever a patient is seen for multiple services, example:
1. Post-op bunionectomy Rt. Hallux
2. New complaint of left ankle sprain
Be sure to separate the Notes into at least separate paragraphs to assist the Appeal Reviewer to see the separate services. Sounds simple, but this works well. Auditors and reviewers have a certain number of reviews to do daily. Making it easy for them to find the required information increases the likelihood of getting paid.
New ICD-10 Codes Released
The Centers for Disease Control and Prevention (CDC) along with the Centers for Medicare & Medicaid Services (CMS) will add new ICD-10 diagnosis codes to be used on healthcare claims. Starting Oct. 1, 2016, there will be 1,943 new diagnosis codes, 422 revised codes and 305 deleted codes impacting physician practices. CMS froze the code set updates to reduce the burden on providers implementing ICD-10 on Oct. 1, 2015. It is expected that there will now be yearly updates to the ICD-10 code set. 
As in the past, Cape Medical Billing updates our software in advance and will adjust charge forms for those clients for whom we provide that support. More info this summer.
2016 Client Newsletter Archive