American Academy of Sleep Medicine

AASM demands that MVP contract with qualified local OCST providers

Thu, 16 May 2013 00:00:00 -0500

In June 2012, New York payer MVP announced a new Sleep Study Benefit program that requires preauthorization for sleep testing and encourages the use of out of center sleep testing (OCST) in many patients. Recently, MVP announced a revision to its medical policy for OSA.

HHS publicizes data on hospital charges

Wed, 08 May 2013 00:00:00 -0500

On May 8, the department of Health and Human Services (HHS) announced an unprecedented initiative to provide consumers with nationwide data on what hospitals charge. HHS explained that by providing this data it hopes that “business and consumers alike can use these data to drive decision-making and reward cost-effective provision of care. In addition to making the data available, HHS is also planning to fund data centers to review and publicize reimbursement data in the future.

AASM demands changes to Cigna’s sleep testing policy

Fri, 19 Apr 2013 00:00:00 -0500

Recently, Cigna Healthcare announced an update to its national medical policy for sleep testing. The new policy, which took effect February 15, 2013 requires preauthorization for all sleep related services.

CMS announces round 2 and National Mail Order competitive bid contracts

Wed, 17 Apr 2013 00:00:00 -0500

On April 9 the Centers for Medicare & Medicaid Services (CMS) announced contract suppliers for the Round 2 and National Mail Order programs of the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program.

Updated Humana policy identifies PAP NAP studies as not separately reimbursable

Wed, 17 Apr 2013 00:00:00 -0500

Humana has published an updated coverage determination for adult sleep studies. The new policy details the payer’s stance on coverage of PAP NAPs - the daytime, abbreviated cardio-respiratory sleep studies to acclimated patients to positive airway pressure (PAP) therapy.

Hypopnea scoring: Meeting requirements of payers and the AASM Scoring Manual

Thu, 28 Mar 2013 00:00:00 -0500

In October 2012 the AASM published the AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications Version 2.0. All AASM accredited sleep centers will be required to follow the new manual by October 1, 2013.

CMS to implement edits on ordering-referring providers

Thu, 21 Mar 2013 00:00:00 -0500

Effective May 1, 2013 the Centers for Medicare & Medicaid Services (CMS) will implement edits that will result in claims denial if the ordering or referring provider is not enrolled in Medicare. To prevent denials, claims submitted on or after May 1 must include the name and national provider identifier (NPI) of the practitioner who ordered or referred the service.

Visit the recently updated AASM Practice Management page

Thu, 21 Mar 2013 00:00:00 -0500

This week, the practice management section of the AASM website was expanded to include new frequently asked questions (FAQs) about coding and billing. New FAQ categories include out of center sleep testing and actigraphy. For updated content, please visit the AASM Practice Management website.

Now available: AASM Coding Education Program (A-CEP)

Thu, 14 Mar 2013 00:00:00 -0500

Last week, the AASM announced a new Coding Education Program (A-CEP) for sleep center coding and billing staff.

CMS announces mandatory Medicare FFS payment reductions due to sequestration

Fri, 08 Mar 2013 00:00:00 -0500

The Medicare Learning Network issued a March 8, 2013, announcement to address mandatory payment reductions in the Medicare Fee-for-Service (FFS) program due to sequestration. In general, Medicare FFS claims with dates-of-service or dates-of-discharge on or after April 1, 2013, will incur a 2 percent reduction in Medicare payment.

Recommendations published by National Commission on Physician Payment Reform

Thu, 07 Mar 2013 00:00:00 -0500

The National Commission on Physician Payment Reform published a report on Mar 4 outlining recommendations for changing how physicians are paid.

CMS contracts with RAND and Urban Institute to validate RUC process

Thu, 07 Mar 2013 00:00:00 -0500

The Affordable Care Act (ACA) requires Medicare to develop validation mechanisms for the relative value units (RVUs) assigned to services paid under the physician fee schedule.

Study finds most physicians lose money after adopting EHRs

Thu, 07 Mar 2013 00:00:00 -0500

According to a study published in HealthAffairs on Mar 4, just 27 percent of practices achieved a positive return on investment five years after implementation of electronic health record (EHR) systems.

2012 a record-breaking year for fraud and abuse recoveries

Thu, 14 Feb 2013 00:00:00 -0500

In a Feb. 11 press release, the Department of Health and Human Services (HHS) announced the publication of the HHS and Department of Justice joint report on their Health Care Fraud and Abuse Control Program. The report indicates that government teams recovered $4.2 Billion in fiscal year 2012. According to the press release, “for every dollar spent on health care-related fraud and abuse investigations in the last three years, the government recovered $7.90. This is the highest three-year average return on investment in the 16-year history of the Health Care Fraud and Abuse (HCFAC) Program.”

CMS issues rule finalizing "Sunshine" act

Thu, 14 Feb 2013 00:00:00 -0500

On Feb. 1, 2013, the Centers for Medicare & Medicaid Services (CMS) published a final rule describing the National Physician Payment Transparency Program, often referred to as the “Sunshine” rule. The rule finalized procedures and processes whereby manufactures or drugs, devices, biologicals, or medical supplies provided under Medicare, Medicaid or CHIP must” report annually to the Secretary certain payments or transfers of value provided to physicians or teaching hospitals.”

HHS releases long-awaited HIPAA final rule

Wed, 13 Feb 2013 00:00:00 -0500

The U.S. Department of Health and Human Services (HHS) released a final rule to expand the Health Insurance Portability and Accountability Act (HIPAA). The effective date of the final rule is March 26, 2013, and covered entities and business associates have 180 days after the effective date to comply with the final rule provisions.

Share your success in telemedicine - submit your suggestions to the AASM

Wed, 13 Feb 2013 00:00:00 -0500

The AASM has long been committed to educating members on future sleep care trends. The AASM is currently gathering information on state and federal laws and reimbursement policies for telemedicine services. The objective is to provide our members information on how to integrate telemedicine in a sleep practice. The AASM would also like to hear from our members who have a successful telemedicine program and willing to share your success with your colleagues.

Sleep Testing – 2013 Updated Payment Information and New Pediatric Sleep Codes

Tue, 05 Feb 2013 00:00:00 -0500

The 2013 Medicare Physician Fee Schedule (MPFS) final rule was published on Nov.16, 2012. Since that time, as a result of the American Taxpayer Relief Act enacted on Jan. 2, 2013, the conversion factor rate used to calculate payment for services has been updated. As a result of the Act, the 26% SGR cut was averted and the 2% sequestration cut was delayed for 2 months.

Medicare EHR meaningful use attestation: 2012 deadline approaching

Thu, 31 Jan 2013 00:00:00 -0500

The attestation deadline for the 2012 Medicare Electronic Health Record (EHR) Incentive Program is February 28, 2013. Eligible professionals who participated in the 2012 reporting period are encouraged to register and attest soon to prevent any delay to incentive payments.

AASM PQRIwizard available at discounted rate

Thu, 24 Jan 2013 00:00:00 -0500

Now is the time to submit for your 2012 PQRS Incentives. When you register through the AASM, the PQRIwizard program is only $225! That’s a savings of $74 compared to the retail price of $299. 2012 PQRS participants are eligible to receive a 0.5% financial incentive payment from CMS, based on your total allowed charges for Physician Fee Schedule (PFS) covered services. To receive your 2012 incentives, reporting must be completed by March 14, 2013.

CMS warns that updated payment rates may not be posted yet

Thu, 17 Jan 2013 00:00:00 -0500

In a Jan. 3 response to enactment of the American Taxpayer Relief Act, the Centers for Medicare & Medicaid Services (CMS) indicated that some carriers may not post updated 2013 Medicare physician payment rates and limiting charges until later in the month. The new law provides for a zero percent update for claims with dates of service on or after Jan. 1, 2013, through Dec. 31, 2013. Claims with dates of service prior to January 1, 2013, are unaffected. Medicare claims administration contractors will be posting the payment rates on their websites no later than Jan. 23, 2013.

New PQRIwizard: Register to begin earning incentive payments

Thu, 17 Jan 2013 00:00:00 -0500

AASM members can register for the new PQRIwizard program for only $225 – a savings of $74 compared to the retail price! The program offers eligible professionals a simple and cost-effective online tool to collect and report quality measure data under the CMS PQRS incentive payment program.

Discover the new AASM Practice Management page

Fri, 11 Jan 2013 00:00:00 -0500

Looking for coding information on the AASM website? We’re excited to announce the launch of our new Practice Management website! The practice management page has all of the resources previously housed in the coding section and includes exciting new content as well.

EHR reporting period ends Dec. 31

Thu, 20 Dec 2012 00:00:00 -0500

Eligible professionals participating in the Medicare or Medicaid Electronic Health Record (EHR) incentive program must complete their reporting period by the end of 2012 in order to receive an incentive payment.

EHR incentive payments reach $8.4B

Thu, 06 Dec 2012 00:00:00 -0500

In a Nov. 28 report, the Centers for Medicare & Medicaid Services announced that $692 million in electronic health record (EHR) incentive payments were distributed to eligible providers in October. Total payments, which began in 2011, have now reached $8.4 billion.

Sleep testing - 2013 payment analysis

Thu, 29 Nov 2012 00:00:00 -0500

The 2013 Medicare Physician Fee Schedule (MPFS) final rule was published on Nov. 16. The fee schedule finalizes payment rates for all physician services, including payment rates for sleep testing. Payment for all services in the MPFS is calculated by multiplying the relative value units (RVUs) assigned to each component of the service by the designated conversion factor for the year. This article provides summary information about the payment rates for sleep testing effective Jan. 1, 2013.

HHS publishes 2013 physician fee schedule

Thu, 15 Nov 2012 00:00:00 -0500

On November 1, the Department of Health and Human Services (HHS) published the display copy of final rule for the 2013 physician fee schedule. The rule describes a 26.5 percent payment cut for all services based on the Sustainable Growth Rate (SGR) formula.

CMS Publishes 2014 Clinical Quality Measures (CQM)

Thu, 01 Nov 2012 00:00:00 -0500

The Centers for Medicare and Medicaid Services (CMS) has announced the clinical quality measures for the Electronic Health Record (EHR) Incentive Program. Starting in 2014, all providers will be required to report the new clinical quality measures regardless of whether they are participating in Stage 1 or Stage 2 of the EHR incentive program.

2013 eRx payment adjustment hardship exemption requests accepted beginning Nov. 1

Tue, 23 Oct 2012 00:00:00 -0500

On Nov 1, 2012, the Centers for Medicare & Medicaid Services (CMS) will begin accepting hardship exemption requests for the 2013 Electronic Prescribing (eRx) payment adjustment. Exemption requests will be accepted through Jan 31, 2013. Hardship exemptions must be submitted electronically through the Quality Reporting Communication Support web page.

Proposed payment cuts may result in access to care issue for Medicare patients

Tue, 23 Oct 2012 00:00:00 -0500

A recent survey conducted by the Medical Group Management Association (MGMA) shows the potential negative impacts of Medicare’s proposed 27% payment cut for 2013. The cut, a result of the sustainable growth rate (SGR) formula, is scheduled to take effect Jan 1, 2013 unless Congress takes action by delaying cuts or repealing the SGR.

New pediatric polysomnography codes published in 2013 CPT Codebook

Tue, 09 Oct 2012 00:00:00 -0500

This month, the American Medical Association (AMA) published the 2013 edition of the CPT codebook. The AASM is excited to announce that CPT 2013 includes two new codes for pediatric polysomnography.

OIG publishes 2013 Work Plan

Tue, 09 Oct 2012 00:00:00 -0500

On Tuesday, Oct. 2, the Office of the Inspector General (OIG) published their Work Plan for 2013. The OIG Work Plan describes activities the OIG will initiate or continue throughout the year. Through its activities, the OIG seeks to fight waste, fraud and abuse in the US Department of Health and Human Services (HHS) programs such as Medicare.

CMS implements programs targeting hospital readmissions and quality of care

Tue, 02 Oct 2012 00:00:00 -0500

On Oct. 1, the Centers for Medicare & Medicaid Services (CMS) implemented two new programs under the Affordable Care Act. The Hospital Value-Based Purchasing Program emphasizes quality of care in the hospital setting by shifting toward a pay-for-performance model. Under the new program, Medicare will withhold 1 percent of reimbursements to acute-care hospitals and redistribute these funds to hospitals that meet high performance standards.

Bipartisan bill introduced to replace Medicare competitive bidding process

Wed, 26 Sep 2012 00:00:00 -0500

On Sept. 21 a bill was introduced in the House of Representatives that would replace the Medicare DMEPOS competitive bidding program with market pricing.

Upcoding of office visits - reported trends spark CMS audit

Tue, 18 Sep 2012 00:00:00 -0500

Two new reports from the Office of the Inspector General (OIG) and The Center for Public Integrity show that billing trends over the past 10 years reflect a steady increase in billing Medicare for higher paying services. This trend was shown to be particularly prevalent in the billing of established patient office visit codes.

CMS publishes stage 2 meaningful use criteria

Tue, 11 Sep 2012 00:00:00 -0500

In late August, the Centers for Medicare & Medicaid Services (CMS) published a final rule specifying the stage 2 criteria for the Electronic Health Record (EHR) incentive program. The incentive program provides substantial incentive payments to health care professionals and hospitals that adopt and meaningful use certified EHR technology.

AASM encourages members to contact UHC to become contracted OCST providers

Thu, 06 Sep 2012 00:00:00 -0500

Last month, AASM staff contact UHC regarding their new process for Advanced Notification and Prior Authorization Requirements for Polysomnography and Portable Monitoring for Sleep Related Breathing Disorders. In discussions with the AASM, UHC has confirmed details of the process.

CGS posts new CPAP denial aid

Thu, 06 Sep 2012 00:00:00 -0500

CGS, the DME Medicare Administrative Contractor (MAC) in Jurisdiction C has developed a denial aid website in an effort to clarify documentation requirements and assist suppliers in understanding denials. The website lists categories of denials for PAP devices. The categories expand to include all possible denials associated with that category. For each denial, the associated documentation requirements are listed. References, including links to complete reference documents, are also included.

CMS announces one-year delay to ICD-10

Thu, 30 Aug 2012 00:00:00 -0500

On Friday, Aug. 24, the Centers for Medicare & Medicaid Services (CMS) published a final rule extending the compliance date for ICD-10 from Oct. 1, 2013 to Oct. 1, 2014.

AASM encourages members to contact UHC to become contracted providers of OCST

Thu, 30 Aug 2012 00:00:00 -0500

In early August, AASM members across the country were contacted by UnitedHealthcare (UHC) regarding their new process for Advanced Notification and Prior Authorization Requirements for Polysomnography and Portable Monitoring for Sleep Related Breathing Disorders. The new process promotes the use of out of center sleep testing (OCST) and establishes an advance notification and/or prior authorization requirement for all in-center sleep testing.

Medicare anti-fraud teams get boost from Affordable Care Act

Wed, 22 Aug 2012 00:00:00 -0500

The federal health reform law will arm Medicare anti-fraud teams with sophisticated tools and funding to better identify individuals seeking to profit from the program.

Aetna set to buy Coventry Health Care

Wed, 22 Aug 2012 00:00:00 -0500

In an Aug. 20 news release, Aetna and Coventry Health Care Inc. announced an agreement under which Aetna will acquire Coventry in a transaction which is valued at $7.3 billion. As a result of the agreement, Aetna is expected to add over 5 million total members across their commercial businesses, Medicare Part D, Medicare advantage and Medicaid. It is estimated that the acquisition will close in mid-2013.

CMS opens Round 1 of DMEPOS Competitive Bidding Recompete

Wed, 22 Aug 2012 00:00:00 -0500

The Centers for Medicare & Medicaid Services (CMS) has announced that registration is open to suppliers interested in participating in Round 1 of the Recompete of the Medicare DMEPOS Competitive Bidding Program. The Competitive Bidding Program was mandated by Congress in 2003. It requires that current fee schedule methodology be replaced with a competitive bid process. Under this process, suppliers operating a particular competitive bidding area (CBA) submit bids for products. View the full article to find which competitive bidding areas are included in the recomplete.

New state-by-state compliance resources

Wed, 15 Aug 2012 00:00:00 -0500

On Aug. 1, the Centers for Medicare & Medicaid Services (CMS) released the Provider Compliance Interactive Map, which provides state-by-state information for organizations that monitor compliance for CMS. The map lists organizations' contact information including websites, email addresses and phone numbers. The map also provides brief descriptions of the types of monitoring performed by each organization.

CMS set to release Final Rule on ICD-10 delay

Wed, 15 Aug 2012 00:00:00 -0500

The Centers for Medicare & Medicaid Services (CMS) is expected to publish a final rule which will announce a delay in the compliance date for ICD-10. As the AASM previously announced, CMS published a proposed rule in April which recommended a one-year delay to the implementation of ICD-10. The new date of compliance would be Oct. 2014. CMS solicited comment on the proposed delay.

Data breaches affect nearly 21 million - reflect need for online security measures

Wed, 08 Aug 2012 00:00:00 -0500

Protected health information data breaches are common, affect millions and can result in large fines. Has your sleep center developed policies and procedures for electronic information security to protect itself against information breaches? Don't let your sleep center be at risk of a data breach.

HHS announces new fraud prevention partnership

Tue, 31 Jul 2012 00:00:00 -0500

The Department of Health and Human Services announced a new fraud prevention partnership comprised of both private and public players. The companies and public organizations have joined efforts to “share information and best practices in order to improve detection and prevent payment of fraudulent health care billings.” Specifically, Secretary Kathleen Sebelius and Attorney General Eric Holder identified a desire to share tips about schemes, billing codes and “geographical fraud hotspots” to encourage quick action. The partnership includes a number of large insurance plans as well as both the US Department of Health and Human Services and the US Department of Justice.

Legislation introduced to delay to Medicare payment cuts by one year

Wed, 25 Jul 2012 00:00:00 -0500

On July 18, Rep. Michael Burgess (R-Texas) introduced legislation to extend Medicare physician payment rates for one year. The bill, called the Assuring Medicare Stability and Access for Seniors Act of 2012, addresses projected cuts to overall payment described in the CY 2013 Medicare Physician Fee Schedule Proposed Rule. The proposed rule, published earlier this month, includes an almost 30% cut to the conversion factor, which is used to establish payment rates for all physician services under Medicare.

CMS publishes CY 2013 Medicare Physician Fee Schedule proposed rule

Tue, 10 Jul 2012 00:00:00 -0500

On Friday, July 6 the Centers for Medicare & Medicaid Services (CMS) published a proposed rule recommending changes to payment for the Medicare program for calendar year (CY) 2013. Recommendations made in the proposed rule will be reviewed and, based on comment from the public, may be finalized in the final rule which will be published in November.

CMS Announces New Refill Requirements for DMEPOS

Tue, 19 Jun 2012 00:00:00 -0500

In simultaneous announcements distributed by all four DME MACs, the Centers for Medicare & Medicaid Services (CMS) has announced a change to the refill requirements for DMEPOS items and supplies provided on a recurring basis. The new requirements cover a number of different types of DMEPOS including but not limited to CPAP.

Version 5010 implementation and eRx hardship exemptions due June 30

Tue, 19 Jun 2012 00:00:00 -0500

The Centers for Medicare & Medicaid Services (CMS) has announced that on June 30, 2012 it will begin enforcement of the required transition to Version 5010 for all HIPAA covered transactions. CMS has announced that on that same date it will begin enforcement of the required transition to Version 5010 for all HIPAA covered transactions.

CMS announces release of Comparative Billing Reports on Evaluation and Management Services

Thu, 24 May 2012 00:00:00 -0500

The Centers for Medicare & Medicaid Services (CMS) announced it will release a Comparative Billing Report (CBR) addressing Evaluation and Management Services on June 4.

Get a sneak peak at proposed changes to the ICSD at SLEEP 2012

Thu, 24 May 2012 00:00:00 -0500

Join the AASM International Classification of Sleep Disorders (ICSD) Revision Task Force members on Tuesday June 12 from 2:45-4:45pm at SLEEP 2012 for the discussion "Developing ICSD-3: Work to Date and Future Directions." The discussion group is chaired by Dr. Michael Sateia, chair of the ICSD Revision Task Force.

CMS delays implementation of the Physician Payments Sunshine Act

Thu, 10 May 2012 00:00:00 -0500

In a blog post on May 3, The Centers for Medicare & Medicaid Services (CMS) announced a delay to implementation of the Physician Payments Sunshine Act. Referred to as the Sunshine Act, the provision was developed to require physicians to disclose any financial compensation worth more than $10 from pharmaceutical or medical device companies.

Review the CPT Guidelines for Sleep Medicine with the experts at SLEEP 2012

Thu, 10 May 2012 00:00:00 -0500

Join the AASM coding and compliance experts at SLEEP 2012 on Tuesday, June 12 from 10:15am-12:15pm for the session "Changes to the CPT Guidelines for SLEEP Medicine Services: How Will They Affect My Practice?" The two-hour session will walk attendees through the new Sleep Medicine Testing Guidelines included in the CPT codebook in 2012.

CMS publishes ordering and referring final rule

Fri, 04 May 2012 00:00:00 -0500

On April 27, the Centers for Medicare & Medicaid Services (CMS) published a final rule on Changes in Provider and Supplier Enrollment, Ordering and Referring, and Documentation Requirements; and Changes in Provider Agreements.

Avoiding the 2013 e-prescribing payment adjustment

Fri, 04 May 2012 00:00:00 -0500

Medicare providers who do not successfully participate in the e-prescribing (eRx) program will be subject to a 1.5 percent reduction in their 2013 Medicare Part B payments. Act now to avoid this significant penalty.

CMS expands competitive bidding for DME – reports significant savings

Thu, 26 Apr 2012 00:00:00 -0500

In an April 18 press release, Centers for Medicare & Medicaid Services (CMS) reported significant savings in the first year of the durable medical equipment (DME) competitive biding program.

Update on availability of specialty code on CMS paper enrollment forms

Thu, 26 Apr 2012 00:00:00 -0500

In a recent Weekly Update article, we reported on the implementation of the sleep specialty code for CMS. The code will be available via the Medicare Provider Enrollment, Chain and Ownership System (PECOS) in May.

Implementation of CMS Specialty Code for Sleep Medicine

Wed, 18 Apr 2012 00:00:00 -0500

In a recent email from staff at the Centers for Medicare & Medicaid Services (CMS), the AASM was notified that the specialty code for sleep medicine will be implemented in May.

CMS proposes one-year delay to implementation of ICD-10

Tue, 10 Apr 2012 00:00:00 -0500

In an April 9 media release, the Centers for Medicare & Medicaid Services (CMS) announced a proposed one year delay to the implementation of the International Classification of Diseases, 10th Edition (ICD-10). CMS noted a number of reasons for delaying implementation.

February 2012 CPT Editorial Panel accepts recommendation to add two codes for pediatric polysomnography

Tue, 10 Apr 2012 00:00:00 -0500

At the February 2012 meeting of the CPT Editorial Panel the American Academy of Sleep Medicine and a number of other specialty societies presented a proposal to add two new CPT codes for pediatric polysomnography and pediatric polysomnography with initiation of PAP.

Avoiding claims errors and increasing compliance

Tue, 03 Apr 2012 00:00:00 -0500

In 2011, it was reported that approximately $28.8B in improper payments were issued across all Medicare Fee-For-Service programs (including Part A, Part B and DME). This is an error rate of 8.6 percent. In 2012, Medicare intends to bring this error rate down to 5.4 percent. It is imperative that all sleep centers implement accurate billing procedures to meet current requirements and reduce errors. To help educate members and sleep center staff on this important issue, the AASM is devoting a full day of its April 21–22 Intermediate Sleep Center Management Series to coding and billing topics including documentation, appeals, developing a compliance plan and more.

Enforcement of Version 5010 delayed by 3 months

Wed, 28 Mar 2012 00:00:00 -0500

The Centers for Medicare & Medicaid Services’ (CMS) Office of E-Health Standards and Services (OESS) has announced that it will not initiate enforcement action through Jun. 30, 2012 against any covered entity required to comply with the updated transaction standards including Version 5010.

CMS updates providers on eRx payment adjustment

Wed, 28 Mar 2012 00:00:00 -0500

In an email update to providers dated March 23, the Centers for Medicare & Medicaid Services (CMS) provided additional information on the Medicare Electronic Prescribing (eRx) Incentive Program and the 2012 eRx payment adjustment.

CMS to hear more cases for exemptions from 2012 eRx penalty

Thu, 15 Mar 2012 00:00:00 -0500

The Center for Medicare & Medicaid Services (CMS) has announced that it will again allow physicians to present their case to be exempted from the 2012 e-prescribing (eRx) penalty program. Contact CMS' Quality Net Help Desk if you have not received a formal notice regarding the final status of an exemption request, or if you believe a mistake led to an eRx penalty.

Coding FAQs - New content posted

Wed, 14 Mar 2012 00:00:00 -0500

The Coding page of the AASM website has been expanded to include new frequently asked questions. The FAQs were developed to help members better understand coding, compliance and policy issues related to sleep medicine.

CMS Continues Transition to 5010

Wed, 14 Mar 2012 00:00:00 -0500

In January, the Centers for Medicare & Medicaid Services announced that it had delayed enforcement of the required implementation of Version 5010 for 90 days. Though originally providers were expected to be in compliance with Version 5010 by Jan 1, 2012, it was projected that enforcement actions would begin on Apr 1, 2012.

Medicare redesigns claims and benefits statement

Thu, 08 Mar 2012 00:00:00 -0500

On March 7, Marilyn Tavenner, Acting Administrator of the Centers for Medicare & Medicaid Services (CMS) announced a redesign of the claims and benefits statement provided to Medicare beneficiaries. CMS has redesigned the statement as a part of its new initiative called “Your Medicare Information: Clearer, Simpler, At Your Fingertips.”

Registration open for the Intermediate Sleep Center Management Course

Thu, 08 Mar 2012 00:00:00 -0500

Join us at the AASM National Office, located in a suburb of Chicago, for a two-day Intermediate Sleep Center Management Course on April 21 and 22. The first day of the course will address accurate billing, issues of fraud and abuse, documentation, and compliance plan development. The second day will highlight mechanisms for expanding your sleep center business such as portable monitoring (OCST), DME, expanding your referral base, optimizing staff and marketing your sleep center. The advanced registration deadline for this course is March 23, so register today!

OIG establishes education website Compliance 101

Thu, 08 Mar 2012 00:00:00 -0500

In an effort to consolidate its compliance-related educational resources, the Office of the Inspector General (OIG) has developed a new website called Compliance 101.

CMS announces Stage 2 of electronic health record implementation

Thu, 01 Mar 2012 00:00:00 -0500

In a press release dated Feb 24, the Centers for Medicare & Medicaid Services (CMS) announced a proposed rule detailing the requirements for stage 2 of the Medicare and Medicaid Electronic Health Record Incentive Programs. The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 established incentives for health care professionals and hospitals that adopt certified electronic health record (EHR) technology and use it in a meaningful way.

Update: the 2012 eRx Incentive Program

Thu, 23 Feb 2012 00:00:00 -0500

The Centers for Medicare & Medicaid Services (CMS) previously announced that eligible professionals who did not become successful electronic prescribers under the 2011 Electronic Prescribing (eRx) Incentive Program are subject to a payment adjustment in 2012. Please review this Medicare Learning Network article regarding how payment adjustments were calculated. A number of AASM members submitted hardship exemption requests in late 2011. Approval of such a request would exempt the physician from eRx Incentive Program payment adjustments. CMS originally intended to publish a report of providers approved for hardship exemption. However, it was announced in January that such a report was not technically feasible due to the large number of requests received.

Registration open for Spring Management Courses

Thu, 16 Feb 2012 00:00:00 -0500

A few spots remain open for the Basics of Sleep Center Management course, which will be held on Mar 3, 2012 at the AASM national office in Darien, IL. Chaired by Dr. Amy Aronsky, the basics course is targeted to new sleep center managers or to staff looking to take on a management role. Sleep center managers will also want to take advantage of the Intermediate Sleep Center Management Series, a two day course chaired by Dr. Eric Olson. The Intermediate Series will be held on Apr 21-22, 2012 at the AASM national office in Darien, IL. Registration for this course is currently available with an advanced registration savings deadline of Mar 23, 2012.

HHS initiating a process to postpone the compliance date for ICD-10

Thu, 16 Feb 2012 00:00:00 -0500

In an news release published Feb 16, 2012, the U.S. Department of Health & Human Services (HHS) announced that HHS is initiating a process to postpone the compliance date for the use of International Classification of Disease, 10th Edition (ICD-10) diagnosis and procedure codes. The current compliance date, as mandated in a January 2009 final rule, is Oct. 1, 2013.

CMS releases guidance on appeals process for 'meaningful use' program

Wed, 01 Feb 2012 00:00:00 -0500

CMS has released guidance about the appeals process for health care providers who have failed to receive meaningful use incentive payments or are seeking to challenge their payout amount. Under the 2009 economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health record systems can qualify for Medicaid and Medicare incentive payments.

Compliance program training podcasts now available

Thu, 26 Jan 2012 00:00:00 -0500

The Office of the Inspector General (OIG) has developed a series of 11 podcasts addressing compliance training topics. The videos posted last week and this week address the development and implementation of a compliance program. In “Compliance Program Basics,” OIG staff highlights their Compliance Program Guidance (CPGs) resources. Tips for Implementing an Effective Compliance Program” builds on the concepts learned in the Basics podcast. The OIG training podcasts are available in audio only and video format on the OIG website. A transcript of each podcast is also available.

Transition to Version 5010

Thu, 26 Jan 2012 00:00:00 -0500

The deadline for implementation of Version 5010 was Jan. 1 2012. However, as previously reported in the Dec 5 2011 Weekly Update, the Centers for Medicare & Medicaid Services (CMS) have delayed enforcement of this requirement for 90 days. Therefore, enforcement actions will not begin until April 1, 2012. In a recent statement, CMS encouraged providers to continue internal and external testing of Version 5010. To assist providers with a smooth transition, CMS has developed a new fact sheet highlighting important steps for health care providers. CMS strongly encourages providers to communicate regularly with applicable vendors. Use of a clearinghouse is also recommended during the transition to ensure that claims are submitted in the proper format. Finally, CMS identifies a number of transition resources, which can be downloaded on the CMS ICD-10 website.

ICD-10 transition podcast now available

Thu, 12 Jan 2012 00:00:00 -0500

In Nov 2011, CMS sponsored an extensive teleconference to prepare providers for the transition to the International Classification of Diseases, 10th Revision (ICD-10). On Jan 4, 2012 CMS announced that it would provide the content of the Nov conference call in a podcast format. The podcast, as well as a number of other ICD-10 transition resources, are available on the CMS website.

HHS establishes HIPAA standards for Electronic Funds Transfers and Remittance Advice Transactions

Thu, 12 Jan 2012 00:00:00 -0500

The Department and of Health and Human Services (HHS) has published an interim final rule, effective Jan. 1, 2012, outlining standards under the Health Insurance Portability and Accountability Act (HIPAA) for Health Care Electronic Funds Transfers (EFT) and Remittance Advice transactions (RA). By standardizing and streamlining electronic transactions, CMS projects that the new standards will reduce administrative costs by $4.5 billion for providers, hospitals, and private and government health plans over the next ten years. CMS anticipates that there will be little to no implementation costs for physician practices and hospitals complying with the new standards. HIPAA covered entities must be in compliance with the standards outlined in the rule by Jan 1, 2014.

OIG develops Stark Law compliance training video

Wed, 04 Jan 2012 00:00:00 -0500

On Jan 3 the Office of the Inspector General (OIG) posted a new compliance training video addressing the Physician Self-Referral Law, also known as the “Stark Law.” A transcript of the presentation is also available.

CMS announces extension of 2012 Annual Participation Enrollment

Tue, 27 Dec 2011 00:00:00 -0500

In an announcement on December 22, the Centers for Medicare & Medicaid notified health professionals of an extension of the 2012 Annual Participation Enrollment Period. The enrollment period will now run Mon Nov 14, 2011 through Tues Feb 14, 2012. Participation elections or withdrawals post-marked on or before Tue Feb 14, 2012 will be accepted. Participation status changes submitted during the extension period (Jan 1 – Feb 14, 2012) will have an effective date of Sun Jan 1, 2012 and will be in force for the entire year.

CMS announces it will hold 2012 claims for 10 business days

Wed, 21 Dec 2011 00:00:00 -0500

In a special announcement published earlier this week, the Centers for Medicare & Medicaid Services (CMS) reported that Medicare claims administration contractors will be instructed to hold claims for services provided in 2012. The claims hold, which will last from Sunday, January 1 through Tuesday, January 17, will impact claims for services provided in 2012 only. Claims for services provided on or before December 31, 2011 will not be affected by this hold. This announcement comes as Medicare providers anticipate the 27.4% cut to payment outlined in the 2012 Medicare Physician Fee Schedule, which is expected to take effect on January 1, 2012. CMS has reported that they expect the claims hold will have a minimal impact on provider cash flow.

OIG issues semiannual report

Mon, 05 Dec 2011 00:00:00 -0500

The Semiannual Report to Congress covers findings, recommendations and activities for the six month period from March 31 to September 30.The highlights of the Semiannual Report note that "for FY 2011, we reported expected recoveries of about $5.2 billion consisting of $627.8 million in audit receivables and $4.6 billion in investigative receivables.” The report outlines the OIG's role in recovery of stolen and misspent funds as well as outreach and training of providers to help them understand rules, statutes and regulations. It also emphasizes the importance of the OIG's continues work to reduce improper payment.

CMS announces 90-day period of enforcement discretion for 5010 compliance

Mon, 05 Dec 2011 00:00:00 -0500

The Centers for Medicare & Medicaid Services’ (CMS) Office of E-Health Standards and Services (OESS) issued a statement on Nov. 17 clarifying their intentions with respect to enforcing compliance with Version 5010. The term Version 5010 refers to the new standards for electronic administrative transactions performed by HIPAA covered entities, such as claims submissions and receipt of remittance advice. The compliance date for use of the new standards continues to be January 1, 2012, as previously announced. However, the OESS indicates in the Nov. 17 statement that they will not initiate enforcement actions against non-compliant entities until March 31, 2012.

Transitioning to ICD-10 – new CMS resources available

Mon, 21 Nov 2011 00:00:00 -0500

Effective Oct. 1, 2013, all Health Insurance Portability and Accountability Act (HIPAA) covered entities will be required to transition to the ICD-10 code sets. To help providers prepare for this transition, the Centers for Medicare & Medicaid Services (CMS) has developed a number of informational handbooks. The handbooks, which are specific to the type and size of the provider’s practice, include relevant timelines and templates to assist in the transition.

CMS revises revalidation of provider enrollment timeline

Tue, 15 Nov 2011 00:00:00 -0500

In a Nov. 4 message, the Centers for Medicare & Medicaid Services (CMS) announced that it will extend the provider enrollment revalidation process for another 2 years. As a result, revalidation notices will be sent through Mar. 2015 (previously Mar. 2013). The provider enrollment revalidation process is required for all providers who enrolled prior to Mar. 25, 2011. Despite the extension of the overall revalidation timeline, providers who have been sent revalidation letters must respond to the request. Revalidation request letters will continue be sent to providers by their Medicare Administrative Contractors (MACs) between now and Mar. 2015. Providers must wait to complete the revalidation process until they receive a request letter from their MAC.

National Government Services reports high CPAP claims error rate

Tue, 08 Nov 2011 00:00:00 -0500

In a recent newsletter, National Government Services (NGS) reported on a recent prepayment medical review of claims for continuous positive airway pressure (CPAP) devices. NGS, the Durable Medical Equipment Medicare Administrative Contractor for Jurisdiction B, reported that the results of the review of 100 claims indicate a claims error rate of 81 percent. NGS reports that following a review of their findings, their Medical Review department will continue prepayment review of claims for CPAP. NGS encourages providers to review their local coverage determination (LCD) for Positive Airway Pressure (PAP) Devices for Treatment of Obstructive Sleep Apnea.

Medicare issues 2012 Physician Fee Schedule display copy

Mon, 07 Nov 2011 00:00:00 -0500

On Nov. 1 the Centers for Medicare & Medicaid Services (CMS) issued a final rule for services paid under the Medicare Physician Fee Schedule (MPFS) for the 2012 calendar year. Comments to the final rule are being accepted by CMS through Jan. 3, 2012.

Medicare implements new fraud detection system

Tue, 01 Nov 2011 00:00:00 -0500

The system, which was mandated in the Small Business Jobs Act of 2010 (SBJA), is designed to detect and flag potentially fraudulent claims in real time. Claims are streamed through the predictive modeling technology as they are submitted. Based on the data in the claims, the system builds profiles of providers, networks, billing patterns and beneficiary utilization. Based on these profiles, CMS can create estimates of fraud and flag potentially fraudulent claims. Though the predictive modeling system is designed to identify potential fraud, claims are not being denied exclusively based on alerts generated by the system at this time.

Submit your electronic prescribing incentive hardship exemption request by Tuesday, Nov. 1

Tue, 25 Oct 2011 00:00:00 -0500

The submission deadline is Tuesday, Nov. 1 for Electronic Prescribing (eRx) Incentive Program hardship requests. Providers must submit requests on the CMS electronic submission site to avoid the Medicare ePrescribing penalty that starts January 1, 2012. Eligible providers who do not successfully prescribe electronically per Centers for Medicare & Medicaid Services (CMS) requirements will receive a penalty of -1 percent of allowable changes.

Medicare Announces National Provider Call about Revalidation of Enrollment

Tue, 18 Oct 2011 00:00:00 -0500

In an August Weekly Update Article, the AASM announced that the Centers for Medicare & Medicaid Services (CMS) will be requiring a revalidation process for providers who enrolled in the Medicare program prior to Mar 25, 2011. CMS has indicated that most providers will need to revalidate enrollment. On Thursday Oct 27 from 12:30-2pm ET, CMS will hold a National Provider Call to review information related to the revalidation process. For more information, and to register for this free session, the AASM has provided a link to the CMS call registration website in the full version of this article.

OIG publishes 2012 Work Plan

Tue, 11 Oct 2011 00:00:00 -0500

On Oct 5 the Department of Health & Human Services (HHS) Office of Inspector General (OIG) announced the publication of the Fiscal Year 2012 HHS OIG Work Plan. The work plan, which can be downloaded for review in its entirety on the OIG website, outlines the items to be addressed by the OIG in the next fiscal year. The 2011 OIG Work Plan highlighted a number of sleep-related projects for the OIG and sleep continues to be an important topic in the 2012 Work Plan.

Submit your electronic prescribing incentive program hardship exemption request by Nov. 1

Tue, 04 Oct 2011 00:00:00 -0500

In a previous announcement about eRx hardship exemptions, the AASM reported that the Sept. 6 Federal Register included a final rule describing changes to the eRx Incentive Program. Beginning in 2012, providers who do not successfully prescribe electronically per Centers for Medicare & Medicaid Services (CMS) requirements will receive a penalty of -1 percent of allowable changes. The final rule outlined six exemption categories for providers who are unable to successfully participate in the eRx program due to hardship. The request submission deadline is Nov. 1.

Final Rule for Medicaid Recovery Audit Contractor (RAC) program released

Thu, 22 Sep 2011 00:00:00 -0500

The Medicaid Recovery Audit Contractor (RAC) program is projected by the U.S. Department of Health and Human Services (HHS) to save $2.1 billion over the next five years by detecting and correcting improper payments by reviewing claims after the payments have been made. The program is based on the existing Medicare Recovery Audit program and will be largely self-funded. The final rule for the Medicaid RAC program goes into effect on January 1, 2012.

CMS switches to postcard mailing to announce open participation enrollment period

Wed, 14 Sep 2011 00:00:00 -0500

The Centers for Medicare & Medicaid Services (CMS) has directed contractors to use postcards announcing the open participation enrollment period this year in place of the CD packets. Previously, the CD packets included an electronic copy of the Medicare Physician Fee Schedule (MPFS). Due to the frequency of last-minute changes to the MPFS in recent years, CMS has directed contractors not to distribute electronic copies. Instead, contractors will keep updated copies of the MPFS and enrollment information on their websites, which will be listed on the postcard. Participating health-care professionals who do not wish to change their participation status will not be required to take any action during the open enrollment period. Postcard announcements will be mailed in early November.

Sleep medicine specialty code delayed until April 2012

Thu, 08 Sep 2011 00:00:00 -0500

In January, the AASM announced that the Centers for Medicare & Medicaid Services (CMS) approved the establishment of a physician specialty code for sleep medicine. The original approval letter from CMS indicated that the code would be established after October 2011. In an email received Thursday September 8, staff from the CMS Provider Enrollment Operations Group notified the AASM that the establishment of the specialty code has been delayed. CMS staff cited system implementation issues, which will prevent the code from being established until April 2012. The AASM will continue to keep members updated regarding this important issue via the Weekly Update. Once the specialty code has been established, members will be provided information about how to change their specialty information with CMS.

CMS publishes final rule on Electronic Prescribing (eRx) Incentive Program

Thu, 08 Sep 2011 00:00:00 -0500

In the Sept. 6 Federal Register, the Centers for Medicare and Medicaid Services (CSM) published a final rule describing changes to the eRx Incentive Program. Beginning in 2012, providers who do not successfully prescribe electronically per CMS requirements will receive a penalty, also known as a payment adjustment, of -1 percent of allowable charges. This adjustment is projected to increase to -1.5 percent in 2013 and -2 percent in 2014.

Providers who believe they cannot meet the requirements of the eRx incentive program due to hardship can apply for exemption from the eRx program. Major changes to the eRx program, as outlined in the final rule, include the addition of new hardship exemption categories as well as an extension of the deadline to submit a hardship exemption request. The exemption deadline is now Nov. 1, 2011.

CMS provides clarification in response to AASM concerns regarding CBRs

Thu, 01 Sep 2011 00:00:00 -0500

In June, the AASM informed members of the Centers for Medicare & Medicaid Services (CMS) providing Comparative Billing Reports (CBR) nationally to the highest frequency billers of sleep medicine services to educate providers regarding proper billing practices. Later, the AASM sent a letter to CMS outlining several concerns about how the CBR analysis was performed and requesting a new CBR analysis be performed two years following the establishment of the sleep medicine designation by CMS.

This week, the AASM received a response from CMS that provides additional information and clarification regarding provider billing, peer groupings, and future design and methodology development based on the sleep medicine specialty designation. It is worthwhile to note the One PI Program reported that 90 percent of providers in the study billed 192 or less services.

OIG Publishes IDTF compliance reports for Miami and Los Angeles

Wed, 31 Aug 2011 00:00:00 -0500

On August 30, the Office of the Inspector General (OIG) published two compliance reports for Independent Diagnostic Testing Facilities (IDTFs). The reports describe unannounced site visits conducted at all fixed location IDTFs in both the Miami and Los Angeles areas. As a result of the unannounced visits conducted in Miami and Los Angeles, the OIG has recommended that more unannounced visits be conducted. Both compliance reports include information regarding the IDTF standards and can serve as helpful tools for IDTFs looking to maintain compliance with CMS requirements.

New projections from CBO include steep Medicare cuts for physicians

Thu, 25 Aug 2011 00:00:00 -0500

According to a recent article from Kaiser Health News, new figures released by the Congressional Budget Office include the imposition of steep Medicare cuts for physicians. The CBO’s new baseline projections of the federal budget estimate that cumulative deficits will reach $3.5 trillion between 2012 and 2021 — a much shallower budget hole than the $6.7 trillion CBO projected in March.

2012 Physician Fee Schedule Proposed Rule: Submit comments to CMS by Tuesday, Aug. 30

Thu, 25 Aug 2011 00:00:00 -0500

On Tuesday, Aug. 9, the AASM sent a comment letter to the Centers for Medicare & Medicaid Services (CMS) outlining concerns regarding the 2012 Physician Fee Schedule Proposed Rule. AASM members also are encouraged to provide CMS with their own comments on the 2012 Physician Fee Schedule Proposed Rule. Comments to CMS are due by Aug. 30 using the contact information found on the first page of the Proposed Rule.

Medicare to include CPAP in second round of DME-POS competitive bidding program

Thu, 25 Aug 2011 00:00:00 -0500

On Friday, Aug. 19, the Centers for Medicare & Medicaid Services (CMS) announced that it will expand the durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) competitive bidding program, which is used to set prices for DME. Among the product categories for Round Two are continuous positive airway pressure (CPAP) devices and respiratory assist devices (RADs) and related supplies and accessories. Bidding for Round Two, which will expand the program from nine cities to 91 areas, will begin this fall.

Medicare Administrative Contractors to begin requesting revalidation

Thu, 18 Aug 2011 00:00:00 -0500

Due to new risk screening criteria required by the Affordable Care Act, providers/suppliers who enrolled in the Medicare program prior to March 25, 2011, will be required to revalidate their Medicare enrollment. Medicare has asked that providers/suppliers do not revalidate until asked to do so by their MAC. Providers/suppliers who enrolled in Medicare after March 25, 2011, have already completed the risk screening process.

Register for the AASM Compliance Program Development Workshop

Thu, 18 Aug 2011 00:00:00 -0500

Now more than ever, sleep medicine is on the radar of the Centers for Medicare & Medicaid Services (CMS) and the Office of the Inspector General (OIG). The AASM strongly recommends that all sleep facilities develop a compliance program, including regular file audits, to help ensure appropriate documentation and billing. AASM members and their coding and billing staff are encouraged to attend the upcoming Compliance Program Development Workshop on Friday, Sept. 16 at the AASM national office in Darien, IL.

AASM submits comment to CMS regarding 2012 Physician Fee Schedule Proposed Rule

Thu, 11 Aug 2011 00:00:00 -0500

On Tuesday, Aug. 9, the AASM sent a comment letter to the Centers for Medicare & Medicaid Services (CMS) outlining concerns regarding the 2012 Physician Fee Schedule Proposed Rule. The AASM comment letter focuses on the four issues included in the full article. Comments to CMS are due by Aug. 30 using the contact information found on the first page of the Proposed Rule.

CMS announces National Version 5010 Testing Week: Aug. 22-26

Wed, 03 Aug 2011 00:00:00 -0500

By Sunday, Jan. 1, 2012, all HIPAA-covered entities are required to be compliant with Version 5010, the new version of the X12 standards for Health Insurance Portability and Accountability Act (HIPAA) transactions. CMS has designated the week of Aug. 22-26, 2011, as National Version 5010 Testing Week to assist in the transition and to encourage providers to perform external testing (Level II) with their Medicare Administrative Contractors (MACs).

AASM provides additional analysis of the CMS 2012 Physician Fee Schedule Proposed Rule

Thu, 28 Jul 2011 00:00:00 -0500

Last week the AASM announced that the Centers for Medicare & Medicaid Services (CMS) had published the 2012 Physician Fee Schedule Proposed Rule in the Federal Register; please note that this is the draft rule and is not final. If implemented, changes outlined in the proposed rule will significantly affect sleep physicians.

CMS to host an ICD-10 national provider call on Wednesday, Aug. 3

Wed, 20 Jul 2011 00:00:00 -0500

Is your office preparing for a smooth transition to ICD-10 on Oct. 1, 2013? To assist you in your preparation, the Centers for Medicare & Medicaid Services (CMS) is going to host a national provider call on "ICD-10 Implementation Strategies for Physicians" on Wednesday, Aug. 3, 2011, from 1 p.m. to 3 p.m. EDT. CMS subject matter experts will discuss ways that physician offices can prepare for the change to ICD-10 for medical diagnosis and inpatient procedure coding. A question and answer session will follow the presentations.

CMS Publishes 2012 Physician Fee Schedule Proposed Rule in the Federal Register

Tue, 19 Jul 2011 00:00:00 -0500

On July 8, the AASM announced that the Centers for Medicare & Medicaid Services (CMS) had released the display copy of the 2012 Physician Fee Schedule Proposed Rule, which is being reviewed and analyzed by AASM staff. This week the Proposed Rule was published online in the Federal Register. The final decisions on the proposed policy and payment changes are scheduled to be published in November 2011 in the final rule.

Comparative Billing Reports: New Resource and AASM Response

Mon, 18 Jul 2011 00:00:00 -0500

As an additional resource, the AASM has developed a template letter to assist members in drafting a response to the CBR Producer. This two-page form letter can be used in whole or in part, and it should be modified to reflect the specifics of each member’s practice. Members interested in responding to the CBR are encouraged to send a personally modified version of the form letter or their own individually crafted letter to the CBR Producer.

CMS Releases a Display Copy of the Proposed Physician Fee Schedule for 2012

Fri, 08 Jul 2011 00:00:00 -0500

On July 1, the Centers for Medicare & Medicaid Services (CMS) released a display copy of the proposed rule for the proposed changes to policy and payment for the Physician Fee Schedule for 2012. If implemented, changes outlined in the proposed rule will significantly affect sleep physicians.

AASM Requests that CMS Exempt Sleep Physicians from eRx Penalties

Fri, 01 Jul 2011 00:00:00 -0500

The AASM’s letter outlines the potential difficulties that sleep specialists will run into when prescribing hypnotics and stimulants in states that do not allow these medications to be prescribed electronically.

Responding to Recent Medicare Comparative Billing Reports: Important Contact Information

Thu, 23 Jun 2011 00:00:00 -0500

The AASM has received feedback from a number of members regarding the recent memo from Dr. Strollo about the Comparative Billing Reports (CBRs) that have been issued on behalf of the Centers for Medicare & Medicaid Services (CMS). A number of members’ questions relate to how one can contact Medicare regarding the CBR content.

How to Respond to Recent Medicare Comparative Billing Reports

Thu, 09 Jun 2011 00:00:00 -0500

Centers for Medicare and Medicaid Services (CMS) provided Comparative Billing Reports (CBRs) nationally to the highest frequency billers of the sleep medicine services to educate providers regarding proper billing practices. Steps to take in response to receiving a Medicare CBR only relate to those sent during May and June 2011 to the highest frequency billers of the following CPT/HCPCS codes: 95805, 95806, 95807, 95808, 95810, 95811, G0398, G0399 and G0400.

IOM Report Examines Geographic Adjustments to Medicare Payments

Fri, 03 Jun 2011 00:00:00 -0500

Earlier this week the Institute of Medicine of the National Academies (IOM) issued a new consensus committee report, “Geographic Adjustment in Medicare Payment: Phase I: Improving Accuracy.” The report, which was sponsored by the Centers for Medicare & Medicaid Services (CMS), examined Medicare’s practice of adjusting fee-for-service payments to hospitals, physicians, and other clinical practitioners according to the geographic locations in which they practice.

OIG Announces $3.4 Billion in Expected Recoveries

Fri, 03 Jun 2011 00:00:00 -0500

On June 1 the Office of the Inspector General (OIG) released a statement announcing that it expects to recover $3.4 billion from investigations, audits and reviews occurring between October 2010 and March 2011, mainly involving Medicare and Medicaid. Coding Corner articles are archived on the Coding Page of the AASM website for future reference.

Medicare Publishes Proposed Rule on Accountable Care Organizations

Fri, 27 May 2011 00:00:00 -0500

In April, Medicare published a proposed rule describing the Shared Savings Program, which is required by the Affordable Care Act to improve outcomes by promoting accountability and quality of care. Providers are encouraged to review the proposed rule and submit comments to Medicare by close of business on June 6, 2011.

CMS Issues Proposed Rule to Revise Medicare Electronic Prescribing Penalty

Thu, 26 May 2011 00:00:00 -0500

The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule for changes to the Medicare Electronic Prescribing (eRx) Incentive Program. The proposed rule is on display at the Federal Register, and the deadline for submitting comments is July 25, 2011.

OIG Presentation Materials from Provider Compliance Training are Available Online

Fri, 20 May 2011 00:00:00 -0500

The Office of Inspector General has posted presentation materials on its website from the recent HEAT Provider Compliance Training webcast.

OIG Offers FREE, Live Webcast of Provider Compliance Training on Wednesday, May 18

Fri, 13 May 2011 00:00:00 -0500

The Office of Inspector General (OIG) will offer a FREE, live webcast of its HEAT Provider Compliance Training, which will be held on Wednesday, May 18, 2011. Hear from Inspector General Daniel Levinson and other government experts as they educate local health care providers and compliance officers about the realities of Medicare fraud and the importance of implementing an effective compliance program.

Are You Considered the Medicare EHR Incentive Program?

Fri, 13 May 2011 00:00:00 -0500

The Medicare Electronic Health Record (EHR) Incentive Program gives providers the opportunity to receive significant incentive payments for the demonstration of meaningful use of EHR technology. Read the full article to learn more about this program.

CMS Comparative Billing Report Examines Billing Practices for Sleep Study Services

Fri, 13 May 2011 00:00:00 -0500

In response to the identification in the Office of Inspector General (OIG) 2010 and 2011 Work Plans of a rapid expansion of sleep study services, a Centers for Medicare & Medicaid Services (CMS) contractor has performed an analysis of billing practices for nine sleep study services. This analysis will be used to provide individual physicians with a Comparative Billing Report (CBR), which will address the services identified by specific CPT codes.

Medicare EHR Incentive Program Attestation Conference Call is Thursday, May 5

Fri, 29 Apr 2011 00:00:00 -0500

CMS is holding a conference call for eligible professionals (EPs) who are participating in the Medicare Electronic Health Record (EHR) Incentive Program to provide information on the attestation process. The focus of the call will be to help guide users through the CMS web-based attestation system. Login to learn more details about the scheduled conference call.

CMS Announces Provider Teleconference on ICD-10 Conversion Activities

Fri, 29 Apr 2011 00:00:00 -0500

Registration is now open for a 90-minute provider call to be held Wednesday, May 18, 2011, from 1 p.m. - 2:30 p.m. EDT to discuss the conversion to ICD-10 within CMS. The call will feature presentations on ICD-10 related topics including Lab NCDs conversion process from ICD-9-CM to ICD-10-CM, Home health conversion, OASIS and procedure code reporting, implementation issues and more.

Attestation for the Medicare EHR Incentive Program Begins

Thu, 21 Apr 2011 00:00:00 -0500

Earlier this week, attestation for the Medicare EHR Incentive Program began. This means that eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) can attest through the CMS web-based attestation system and be on the way to receiving Medicare EHR incentive payments.

CMS Implementation of Provider Enrollment Provisions

Fri, 15 Apr 2011 00:00:00 -0500

The Feb. 2, 2011, edition of the Federal Register outlined a number of new requirements for CMS providers and suppliers. The final rule, which took effect March 25, 2011 included new requirements for the screening process, application fees and temporary moratoria.

CMS Open Forum on the Physician Quality Reporting System is April 14

Fri, 08 Apr 2011 00:00:00 -0500

The Centers for Medicare & Medicaid Services will host a Special Open Door Forum on the 2011 Physician Quality Reporting System and E-Prescribing Incentive programs. The live conference call will take place on Thursday, April 14, 2011 and will feature three presentations that focus on success stories.

AMA Introduces New CPT E/M Quick Reference Mobile App

Fri, 01 Apr 2011 00:00:00 -0500

The American Medical Association introduced a new mobile application that helps you easily determine the appropriate CPT Evaluation and Management (E/M) code for use for billing. Featuring both decision-tree logic and quick search options, the application allows you to digitally track codes and email them anywhere.

CMS to Host National Provider Education Calls for Electronic Health Record Incentive Program

Fri, 25 Mar 2011 00:00:00 -0500

The Centers for Medicare & Medicaid Services (CMS) will hold two national provider education calls for professionals and hospitals about registration for the Medicare Electronic Health Records (EHR) Incentive Program.

Office of the Inspector General Publishes 2011 Work Plan

Fri, 25 Mar 2011 00:00:00 -0500

The OIG work plan for fiscal year 2011 describes audits and evaluations underway and under development. The plan provides readers with insight into the main areas under investigation by the OIG and outlines the OIG's enforcement and compliance activities. Login to find out the sleep-related initiatives included in the work plan for 2011.

Medicare Primary Care Incentive Payment (PCIP) Eligibility Data Updated on Contractor Websites

Fri, 18 Mar 2011 00:00:00 -0500

Physicians who are identified by Medicare as primary care physicians with a specific percent of Part B allowed charges for primary care services are eligible for a 10 percent bonus payment. Physicians wishing to confirm eligibility must visit contractor websites.

Physicians Scheduled To Receive 29.5% Medicare Pay Cut in 2012

Fri, 18 Mar 2011 00:00:00 -0500

Medicare officials recently announced that physicians face a 29.5-percent cut in Medicare reimbursement in 2012 unless lawmakers act to prevent the reduction.

New Oral Appliance Therapy for OSA LCDs Published

Fri, 18 Feb 2011 00:00:00 -0500

Recently, the four area DME MACs published draft Local Coverage Determinations (LCDs) addressing oral appliance therapy for obstructive sleep apnea. These four policies took effect Jan. 3, 2011.

2011 Medicare Physician Fee Schedule Final Rule Summary Overview

Thu, 17 Feb 2011 00:00:00 -0500

Beginning in November 2010, the AASM sent out regular updates to members related to the 2011 Medicare Physician Fee Schedule (MPFS) Final Rule. To avoid confusion and help clarify payment changes, we have developed an overview of the MPFS Final Rule including a timeline of events, national payment information, instructions for finding local payment information and a glossary of key terms.

Reprocessing Targeted Medicare Claims for Portions of 2010

Thu, 10 Feb 2011 00:00:00 -0500

New legislation and recent corrections to the 2010 Medicare Physician Fee Schedule (MPFS) call for reprocessing of a large volume of Medicare fee-for-service claims. Given this large workload, the Centers for Medicare & Medicaid Services (CMS) is taking steps to ensure that new claims coming into the Medicare program are processed timely and accurately, even as the retroactive adjustments are being made.

Contractors Revise Local Coverage Determinations for Sleep Studies

Fri, 04 Feb 2011 00:00:00 -0500

Recently, four Medicare Part B Contractors – National Government Services, Palmetto, Highmark, and Wisconsin Physicians Service – revised local coverage determination (LCD) policies for sleep studies.

The Transition to ICD-10: Version 5010

Thu, 27 Jan 2011 00:00:00 -0500

Effective Oct. 1, 2013, diagnostic coding in all health-care settings will change from ICD-9 to ICD-10. To accommodate the changes to the code structure resulting from this transition, CMS is requiring an update to the transaction standards used for electronic health-care claims. The current standards, Version 4010/4010A, must be upgraded to Version 5010 by Jan. 1, 2012.

CMS Approves AASM Request for a Medicare Physician Specialty Code for Sleep Medicine

Thu, 27 Jan 2011 00:00:00 -0500

Earlier this week, the Centers for Medicare & Medicaid Services (CMS) notified the AASM that it will be establishing a Medicare physician specialty code for sleep medicine. The letter noted the important work that sleep medicine physicians provide for Medicare beneficiaries and stated that the request submitted by the AASM met all of the criteria for approval.

The Transition to ICD-10: What Will Change?

Fri, 14 Jan 2011 00:00:00 -0500

Effective Oct. 1, 2013, diagnostic coding in all health care settings will change from the International Classification of Diseases Ninth Revision (ICD-9) to the Tenth Revision (ICD-10). Hit the jump to learn the highlights the biggest differences between the ICD-9 and ICD-10.

Special Update: CMS Revises Sleep Medicine CPT Code

Fri, 07 Jan 2011 00:00:00 -0500

The Centers for Medicare & Medicaid Services (CMS) has released a revision to the 2011 Physician Fee Schedule that adjusts calculations of the Medicare payment rates. The revision includes adjustments to the conversion factor and fees for services, including sleep medicine codes.

CMS Publishes Change to Conversion Factor

Thu, 30 Dec 2010 00:00:00 -0500

In an Emergency Update to the CY 2011 Medicare Physician Fee Schedule (MPFS) Database published Dec. 29, 2010, the Centers for Medicare & Medicaid Services (CMS) revised the conversion factor from the December 2010 rate of $36.8729 to a new rate of $33.9764 effective Jan. 1, 2011.

President Obama Signs “The Medicare and Medicaid Extenders Act of 2010” into Law

Fri, 17 Dec 2010 00:00:00 -0500

On Wednesday President Obama signed into law “The Medicare and Medicaid Extenders Act of 2010” (HR 4994), which will extend current Medicare reimbursement rates until Jan. 1, 2012.

The law prevents the scheduled reduction to the overall rate of physician reimbursement for services provided to Medicare beneficiaries. The conversion factor, one of the key elements of the Medicare payment formula, will remain at $36.87 for 2011.

Information on Sleep Medicine Codes 95800 and 95801

Thu, 09 Dec 2010 00:00:00 -0500

Published in the 2011 Physician Fee Schedule is information on payment for sleep medicine codes, including national values for physician work, practice expense and professional liability insurance RVUs. The new values for the RVUs are effective January 1, 2011.

Senate Approves 1-Year Delay to Medicare Payment Cuts for Physicians

Thu, 09 Dec 2010 00:00:00 -0500

On Wednesday the Senate unanimously approved by voice vote a bipartisan bill (HR 4994) that would delay scheduled cuts, which were the result of the SGR, to physicians' Medicare payments for one year.

2011 Physician Fee Schedule: Final Rule Released

Mon, 29 Nov 2010 00:00:00 -0500

The final version of the 2011 Physician Fee Schedule Final Rule was released by the Centers for Medicare & Medicaid Services (CMS) Monday. The RVU values for sleep medicine codes are unchanged from the display copy of the Final Rule. The AASM is reviewing the Final Rule in detail and will provide members with updated information shortly.