The Office of the Inspector General has released a report on the first level of the appeals process for Medicare Parts A and B from 2008-2012. Medicare refers to the process for the first level of appeals as redetermination. In 2012, contractors processed 2.9 million redeterminations, which involved 3.7 million claims, an increase of 33 percent since 2008. Although 80 percent of all redeterminations in 2012 involved Part B services, redeterminations involving Part A services have risen more rapidly. In 2012, the Medicare program denied 139,275486 million claims, but providers only appealed 3,664,599 million claims which amounts only to 2.6%

Noridian Healthcare Solutions has announced they will conduct a SNF specific probe review in the state of Nevada. Noridian will review 100 claims with edit number 50204 for claims billed on or after 11/1/2013 with following criteria: Original SNF claims RUG RV* This service specific review is initiated based on the following: Data analysis has identified a potentially high use of SNF claims billed with very high intensity rehabilitation services (RV*).

The Centers for Medicare and Medicaid Services (CMS) has issued clarification on the definition of the patient as being “confined to the home” to more accurately reflect the definition as articulated at Section 1835(a) of the Social Security Act. In addition, vague terms, such as “generally speaking”, have been removed to ensure clear and specific requirements of the definition. These changes present the requirements first and more closely align the policy manual with the Act. This will prevent confusion, promote a clearer enforcement of the statute, and provide more definitive guidance to HHAs in order to foster compliance. To access

The Office for Civil Rights and Office of the National Coordinator for Health Information Technology have collaborated to develop model Notices of Privacy Practices for health care providers and health plans to use to communicate with their patients and plan members. The HIPAA Privacy Rule gives individuals a fundamental right to be informed of the privacy practices of health plans and health care providers, as well as to be informed of their privacy rights with respect to their personal health information. Health plans and covered health care providers are required to develop and distribute a notice that provides a clear,

Cigna Government Services (CGS), Medicare Administrative Contractor for the states of Kentucky and Ohio, will be providing a webinar on the difference between a reopening and a redetermination on November 13, 2013 beginning at 10:00am ET. This webinar is for private practices in the above mentioned states. To register for the webinar, click HERE.

On September 26, 2013, the Centers for Medicare and Medicaid Services (CMS) announced that government recovery auditors will delay scrutiny of short inpatient stays for 90 days while providers get acclimated to the new policy. Recovery auditor contractors have been told by CMS that they will not be allowed to question the medical necessity of inpatient claims lasting a day or less between October 1, 2013 and December 31, 2013. The two-midnights rule says that hospital stays that last two days—defined as a stay that spans at least two midnights—are presumed to be legitimate uses of inpatient care and will

The Centers for Medicare and Medicaid Services (CMS) has issued guidance and clarification on acceptable submission methods when providers receive an additional development request (ADR). The clarification includes information on what documentation submission methods contractors will accept from providers and CMS recommends Medicare contractors to provide an actual physical address instead of a P.O. Box for submission of records, although it is not mandated. To view the methods of submission, click

The Centers for Medicare and Medicaid Services (CMS) has developed an online ICD-10 implementation guide. This web-based tool, released as part of Health IT Week, includes a basic overview of ICD-10 as well as step-by-step guidance on how to transition to ICD-10 for small/medium practices, large practices, small hospitals, and payers. Users can easily navigate to information that is most relevant to them—wherever they are in the implementation process. The online guide also includes links to CMS ICD-10 resources and other tools to help with the ICD-10 transition. To access the guide, click