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| REGULATORY UPDATES |
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 ICD-9-CM
ANNUAL UPDATE
The complete lists of new,
revised and deleted ICD-9-CM codes and the ICD-9-CM
Guidelines for Coding and Reporting are available.
New Diagnosis Codes
Revised Diagnosis Codes
Invalid Diagnosis Codes |
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Hurricane Gustav - State of Emergency Notices
Similar to Hurricane Katrina and the flooding in Iowa earlier this year, CMS has issued a waiver of some COP requirements for the areas within the public health emergency declaration areas. The 1135 Waiver speaks to the waived requirements (state license, etc.). The Gustav QAs list answers to FAQs. |
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Dropped MDS 3.0 items
Draft MDS 3.0 Dropped Items includes information about Dropped MDS 2.0 items are not included in this Draft MDS 2.0/ MDS 3.0 Crosswalk.
Changes in MDS 3.0 items from MDS 2.0 items are based on results from the following: national MDS 3.0 study, national STRIVE study, CARE tool testing and recommendations from national experts in the long term care industry who participated in technical expert panels.
The MDS 3.0 form will be finalized in March 2009 following completion of the evaluation and analysis of the impact of all potential items on various systems. |
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Draft MDS 2.0 to 3.0 Crosswalk
The Draft MDS 2.0 MDS 3.0 Crosswalk incorporates the MDS 3.0 items currently proposed for implementation in October 2009. CMS anticipates that the vast majority of items contained in this initial draft crosswalk will appear on the final MDS 3.0. However, ongoing research and analysis could result in additions, deletions or revisions. The final list of MDS 3.0 items will be available by March 2009. |
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LTC Federal Fire Safety Requirements - Automatic Sprinkler Systems
The fire safety requirements for Medicare/Medicaid certified long term care facilities, automatic sprinkler systems was published in the Federal Register on August 13, 2008. This final rule requires all edicare/Medicaid certified long term care facilities to be equipped with sprinkler systems by August 13, 2013. |
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Medicare Payments Could be Reduced if Overdue Taxes are Owed to the IRS
The Taxpayer Relief Act of 1997, Section 1024, authorizes the IRS to reduce certain federal payments, including Medicare payments, to allow collection of overdue taxes. Effective October 1, 2008, if a provider owes taxes to IRS, Medicare payment may be adjusted accordingly. When such adjustments occur, the remittance advice will reflect a provider level adjustment code (PLB) of “WU” in the PLB03-1 data field. Under current privacy rules and regulations, only the IRS may discuss the tax issue with the provider. |
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Special Focus Facility (“SFF”) Initiative |
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CMS Survey & Certification Letter - QIO 9th Scope of Work |
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HHS Proposes Adoption of Updated Electronic Transaction Standards |
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HHS Proposes Adoption of ICD-10 Code Sets |
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CMS Forms and Instructions |
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FY 2009 ICD-9-CM Official Guidelines for Coding and Reporting
The ICD-9-CM Official Guidelines for Coding and Reporting are a set of rules that have been developed by the Centers for Medicare and Medicaid Services and the National Center for Health Statistics. The guidelines accompany and complement the official conventions and instructions provided within the 3 volumes of the ICD-9-CM itself. Adherence to the guidelines when assigning ICD-9-CM diagnosis codes is required under the Health Insurance Portability an Accountability Act (HIPAA). |
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CMS REVISES THE MDS 3.0 Implementation Timeline
CMS contracted with RAND Corporation and Harvard to undertake a significant revision and national testing of Version 3.0 of the MDS. In April 2008, RAND presented CMS with their final report concluding that improvements incorporated in the MDS 3.0 produced a more efficient assessment and recommended that CMS adopt the MDS 3.0. Moving forward with the MDS 3.0, CMS published a revised Implementation Timeline. |
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RAC Demonstration Evaluation Report June 2008
The purpose of this report is to evaluate the RAC
demonstration and to share with all interested parties
information about the demonstration. Congress
authorized the RAC demonstration for the purpose
of identifying underpayments and overpayments
and recouping overpayments under part A or B of
the Medicare program. |
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Medicare Signature Requirements - Stamped Signatures not acceptable
The Centers for Medicare & Medicaid Services (CMS) has taken this step to ensure accurate application of Medicare's program requirements throughout the nation. CMS has identified problems of noncompliance with existing statutes, regulations, rules, and other systematic problems relating to standards of practice for a valid physician's signature on medical orders and related medical documents. |
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CMS RAI MDS 2.0 UPDATE |
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MEDICARE INCREASES NURSING HOME PAYMENT RATES, RECALIBRATION OF RUGS TO BE STUDIED FURTHER
Medicare payment rates to nursing homes will increase by $780 million next year, the Centers for Medicare & Medicaid Services (CMS) announced today.
The boost in payments is the result of a 3.4 percent increase in the annual market basket calculation of the cost of goods and services included in a skilled nursing facility stay. |
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CMS Transmittal 1555 - Revision of the Requirements for Denial of Payment for New Admissions (DPNA) for Skilled Nursing Facility (SNF) Billing |
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RAND - MDS Final Report Appendix |
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RAND - MDS Final Report |
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Advanced Copy - Revised F 325 Nutrition and F 371 Kitchen Sanitation
Revised Surveyor guidance for Nutrition (F325) and Sanitary Conditions (F371) will become effective on September 1, 2008. At that time a final copy of the guidance will be published by CMS and incorporated into Appendix PP of the State Operations Manual. The revised guidance deletes Tag F326 and incorporates the guidance into Tag F325. |
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Medicare Payment Advisory Commission Recommends a Revised Prospective Payment System for SNFs
Reports issues in March and June each year are the primary sources for Commission recommendations. In the June 2008 Report to the Congress: Reforming the Delivery System, the Commission: Describes a direction for Medicare payment and delivery system reform.
To learn more, read the entire article. |
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New "Five Star" System to be Added to Nursing Home Compare Site
The Centers for Medicare & Medicaid Services announced it will soon launch a
ranking system of America’s nursing homes, giving each a “star” rating. |
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Payments for Outpatient Services on Behalf of Beneficiaries in SNF Stays
We found that for CYs 2001-2002, Medicare Part B made a total of $106.9 million in potential overpayments to suppliers of outpatient hospital, laboratory, and radiology services on behalf of beneficiaries in SNF stays during which these services were already covered by Part A. |
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New Medicare Competitive Bidding Program for DMEPOS
To view the detailed list of contract supplier for each MSA, please click on this link
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Charges to Hold a Bed During Skilled Nursing Facility Absence
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Role of Nursing Homes & Long Term Care Pharmacies in Assisting Dual-Eligible Residents with Selecting Part D Plans
State Surveyors can cite a nursing home with a deficiency if it fails to allow beneficiaries the right to choose their Part D plans. In a memorandum to State Survey Agency Directors, CMS provided additional guidance about this requirement. |
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“Multi-Provider Complex/Sub-Unit” relationship
An initial enrollment for a sub-unit
will be assigned to the FI or MAC that currently serves the
existing parent hospital – even if the parent hospital is not
presently billing in accordance with the “geographic
assignment rule.” Each such case is fact-specific and will be
treated on an individual basis. (read more) |
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CMS Proposes More Accurate Payment Rates for Medicare Skilled Nursing Facilities in FY 2009
May 1, 2008
FY 2009 Proposed Rule Case Mix Indices (CMIs) Recalibration
- The recalibrated CMIs were calculated based on the Calendar Year (CY) 2006 RUG distribution.
- CMS used the following information to calculate the percentage adjustment necessary to recalibrate nursing CMIs... (read more) |
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New Contractor Numbers for J12 MAC Part A and B
Delaware, Maryland, New Jersey, Pennsylvania and D.C.
Part A and Part B claims for Delaware, District of Columbia, Maryland, New Jersey and Pennsylvania will be processed by the J12 MAC. The purpose of this change request is to notify all interested parties that CMS needs to change the contract numbers in... (read more) |
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Nursing Home Enforcement: Processing Denials of Medicare Payments
"During FY 2004, 74 percent of denial of payment remedies were processed incorrectly, resulting in overpayments exceeding $5 million. In 40 percent of cases, errors resulted in one or more inappropriate payments to skilled nursing facilities.'... " (read more) |
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2008 Action Plan for Further Improvement of Nursing Home Quality
April 25, 2008
The “2008 Action Plan for Further Improvement of Nursing Home Quality” consists of several inter-related and coordinated approaches:
- Consumer Awareness and Assistance: to include an increasing array of information about long-term care that will be written in an easy-to-understand format and available to the public. (read more) |
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Draft OIG Supplemental Compliance Guidance for Nursing Facilities Federal Register April 16, 2008
This Federal Register proposed notice seeks the comments of interested parties on a draft supplemental compliance program guidance (CPG) for nursing facilities. When OIG publishes the final version of this guidance, it will supplement OIG's prior CPG for nursing facilities issued in 2000. |
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OIG Self-Disclosure Letter
April 15, 2008
Cooperative Self-Disclosers May Avoid Integrity Obligations (read more) |
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Fiscal Year 2008 OIG Work Plan
October 24, 2007
Each Fiscal Year (FY), the Office of Inspector General (OIG) conducts a comprehensive workplanning process to identify programs and operations within the Department of Health and Human Services (DHHS) deemed most worthy of OIG attention. (read more)
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