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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.
Audit trails show which of your claims were accepted by the Cahaba GBA Part B processing system, along with claims that were rejected and the reason for the rejection. Referring to this report will allow you to correct and resubmit claims quickly, resulting in a dramatically reduced turnaround time. You will also become aware of […]
Audit trails show which of your claims were accepted by the Cahaba GBA Part B processing system, along with claims that were rejected and the reason for the rejection. Referring to this report will allow you to correct and resubmit claims quickly, resulting in a dramatically reduced turnaround time. You will also become aware of […]
The 2008 Work Plan is a PDF format copy of the entire official publication. The project areas described in this Office of Inspector General (OIG) Work Plan reflect what the OIG believes at the beginning of each fiscal year best identifies vulnerabilities of Department of Health & Human Services’ (HHS) programs and activities. They intend […]
These links go to CDC for the latest information on ICD-9-CM. ICD-9 Classification of Diseases, Functioning, and Disability web page. ICD-9-CM web page ICD-9-CM Files via FTP (2010) ICD-9-CM Files via FTP (2011) ICD-9-CM 2011 Addenda and Conversion table These pdf files include Addenda and Errata for 2008 – 2011 ICD-9 Provider & Diagnostic Codes […]
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 […]
These links go to the CMS website. Medically Unlikely Edits: Main Page Medically Unlikely Edits: NCCI NCCI Edit FAQ Zip files: Practitioner Services MUE Table – Effective 1/1/20 Practitioner Services MUE Table – Effective 10/1/19 Practitioner Services MUE Table – Effective 1/1/19 Facility Outpatient Hospital Services MUE Table – Effective 01-01-2020 (ZIP) DME Supplier Services […]
