Medicare Internet-Only Manuals Links to all Manuals. The Internet-only Manuals (IOMs) are a replica of the Agency’s official record copy. They are CMS’ program issuances, day-to-day operating instructions, policies, and procedures that are based on statutes, regulations, guidelines, models, and directives. The CMS program components, providers, contractors, Medicare Advantage organizations and state survey agencies use […]

MedPAC Releases Updated Medicare Payment Basics Documents On October 7, 2008, the Medicare Payment Advisory Commission (MedPAC) released documents for its Medicare Payment Basics series, which provide an overview of 18 Medicare payment systems.  To view the documents, visit the Medicare Payment Basics page of the MedPAC website or click on any of the following […]

Billing for Observation – Update Observation services should not be billed concurrently with diagnostic or therapeutic services for which active monitoring is a part of the procedure (e.g., colonoscopy, chemotherapy). In situations where such a procedure interrupts observation services, hospitals would record for eachperiod of observation services the beginning and ending times during the hospital […]

CMS-HINN 12 Instructions Hospitals provide Hospital-Issued Notices of Noncoverage (HINNs) to beneficiaries prior to admission, at admission, or at any point during an inpatient stay if the hospital determines that the care the beneficiary is receiving, or is about to receive, is not covered because it is: Not medically necessary; Not delivered in the most […]

IRS Can Levy Medicare Payments Effective October 1, 2008, Medicare payments to physicians may be reduced by the amount of tax owed to the IRS. This directive impacts providers submitting claims to Medicare contractors for services provided to Medicare beneficiaries. Click to view Pub 100-20 One Time Notification Click to view MLN Matters News Flash

Hospital Acquired Conditions On July 31, 2008, in the Inpatient Prospective Payment System (IPPS) Fiscal Year (FY) 2009 Final Rule, CMS included 10 categories of conditions that were selected for the HAC payment provision. Payment implications began October 1, 2008, for these Hospital Acquired Conditions.  The IPPS FY 2009 Final Rule is available in the Statute/Regulations/Program […]

This document describes a change by CMS regarding IPPS and LTCHs. It is 4 pages in pdf format. Click here to view or download.

GLOSSARY OF TERMS FOR REIMBURSEMENT AND COMPLIANCE Adjudication: The payer’s act of processing a claim submitted for reimbursement. Adjustment: An amount which is uncollectible by the practice, from either the patient or the insurance company, due to contractual or legal obligations to accept a lower amount as payment in full — and is therefore “written […]

CURRENT HEALTHCARE ACRONYMS AHA: American Hospital Association AHRQ:Agency for Health Care Research and Quality ASC:Ambulatory Surgical Center CAH:Critical Access Hospital CDHC:Consumer Directed Health Care CMI:Case Mix Index CMS:Centers for Medicare & Medicaid Services DRA:Deficit Reduction Act 2005 DRG:Diagnosis Related Group EMR:Electronic Medical Record FFY:Federal Fiscal Year HCAHPS:Hospital Consumer Assessment of Healthcare Providers and Systems HCRIS:Hospital […]