ICD-10 and Claim Submission

In the linked special edition article, the Centers for Medicare & Medicaid Services (CMS) clarifies policy for processing split claims for institutional providers that span the International Classification of Diseases, 10th Edition (ICD-10) implementation date of October 1, 2014. ICD-9 codes are effective for that portion of the services rendered on September 30, 2014, and…

CMS Releases 2 Proposed Rules

During the week of May 6, 2013, the Centers for Medicare & Medicaid Services (CMS) issued 2 proposed rules. On May 6, 2103, CMS released the proposed rule for Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2014. On May 8, 2013, CMS released the proposed rule for Inpatient Rehabilitation Facility…

MPPR Not Applied Correctly

Beginning in 2013, outpatient therapy services provided in CAH settings should be included in the beneficiary’s therapy cap and threshold total, using the amount that would be payable if the services were paid under the Medicare Physician Fee Schedule. Payments for outpatient hospital therapy services include a multiple procedure payment reduction when more than one…