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CMS to expand quality initiatives
On April 14, CMS issued a new proposal to expand two key initiatives that link Medicare reimbursement for health care services to quality of care. For the Hospital-Acquired Conditions (HACs), CMS is looking to expand the list of conditions by nine to a total of 17 conditions. This means that, if approved, starting October 1, 2008, Medicare will no longer pay a hospital at a higher rate for these conditions.
The second initiative involves the hospital quality measure reporting program. CMS is proposing to expand the list of 43 quality measures to 73 quality measures starting in 2009.
For more information,
Click here to view the press release, then click on the link for "CMS PROPOSES TO EXPAND QUALITY PROGRAM FOR HOSPITAL INPATIENT SERVICES IN FY 2009".
Tricenturion Transition
Important information regarding the transition of medical review not in support of benefit integrity from TRICENTURION, the region AB Program Safeguard Contractor, to the Medicare Affiliated Contractors for jurisdiction A and B has been posted via the Tricenturion website.
For more information,
click here to view this information in its entirety..
CMS Releases January 2008 update of the Hospital Outpatient Prospective Payment System (OPPS)
CMS has released the January 2008 update of the Hospital Outpatient Prospective Payment System (OPPS). Transmittal 1417 is quite lengthy and includes important changes regarding billing of wound care services. The information is related to CPT codes 97597, 97598, 97602, 97605 and 97606.
For more information,
click here to view this information in its entirety..
Tricenturion Transition
Important information regarding the transition of medical review not in support of benefit integrity from TRICENTURION, the region AB Program Safeguard Contractor, to the Medicare Affiliated Contractors for jurisdiction A and B has been posted via the Tricenturion website.
For more information,
click here to view this information in its entirety..
Recent Results Released regarding Pre-payment review for Foam Dressings
TriCenturion, the Jurisdiction A/B DME PSC, has completed the 1st quarter of a widespread,
pre-payment review of Foam Dressings, HCPCS A6209-A6214, billed with the A1 modifier.
The data analysis identified a significant number of beneficiaries who received excessive dressings as
compared to the LCD allowable number of services (NOS). 98% of the claims were denied as Medicare policy
criteria were not met.
To read this article in it's entirety use the following website link
For more information,
read the article.
Final OPPS Rule released by CMS
On November 1, 2007 The Centers for Medicare & Medicaid Services (CMS)issued the
final rule updating the hospital Outpatient Prospective Payment System (OPPS),
effective for services furnished during calendar year (CY) 2008, which encourages
higher quality and accessible health care through new payment policies and the
reporting of quality measures.
This final rule affects outpatient services furnished by general acute care
hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities,
and long-term acute care hospitals.
For more information,
read the article.
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