The new 2009 CPT codes are effective January 1, 2009 and the changes are numerous.  There are 17 new Evaluation and Management (E/M) codes which include pediatric critical care services and special E/M services like newborn care.  Changes also include 33 new surgical codes such as laparoscopies, 67 new medicine codes including vaccines, ESRD, cardiovascular device monitoring, and infusions and injections, and 148 new Category II codes.  In total there are 291 new codes, 375 revised codes and 95 deleted codes and that is just CPT.  HCPCS Level II code changes are numerous as well with 160 new codes, 187 revised and 77 deleted codes.  Make sure your staff is aware of the changes that affect them and make sure your superbills and computer systems are ready to go by January 1, 2009.

The 2009 OPPS final rule was published in the Federal Register on November 18, 2008.  Some highlights include CMS’ projection that payment rates for 2009 will result in a 3.9% increase in Medicare payments for providers paid under OPPS, payment reductions for not reporting quality measures, composite APCs for imaging services, and the addition of 30 surgical procedures to the ASC list of covered surgical procedures.

To view the final rule, go to: http://edocket.access.gpo.gov/2008/pdf/E8-26212.pdf

To view the CMS fact sheet summary, click here: factsheet

Senator Tom Daschle (Dem. SD) has been nominated to serve as the Secretary of the U.S. Department of Health and Human Services under the Obama administration.  He has accepted the nomination and now it is up to the Senate to confirm him.

While the announcement of the four Recovery Audit Contractors (RACs) was recently announced, protests filed by two organizations not awarded the contract has put a stop to the program.  The delay is expected to last until February when a decision will be made by the Government Accountability Office (GAO) regarding the protests.

For more information, go to: http://www.cms.hhs.gov/RAC/

CMS has issued a transmittal updating the “Interpretive Guidelines for Hospitals” which includes updates to the CoPs for Hospitals (42 CFR Part 482), including §482.13 – Patient Rights (see page 65 of link below), §482.21 Quality Assessment and Performance Improvement Program (page 141) and §482.22 Medical Staff (page 150), §482.51 – Surgical Services (page 317) and many others.

Hospitals will want to review this information and update their policies and procedures as necessary.

To view Transmittal 37, go to: R37SOMA.pdf

CMS issued Change Request 6196 in their October 2008 Update of the Hospital Outpatient Prospective Payment System pertaining to the precise assignment of revenue codes for billing. Specifically, CMS says to use the most precise revenue code and use the more detailed subcategory rather than using codes that end in “0” or “9”.

CMS also reiterates that hospitals are required to follow the Medicare cost apportionment regulations at 42 CFR 413.53(a)(1) which states the cost of each ancillary department is to be apportioned separately rather than being combined with another department.

CMS also points you to the Provider Reimbursement Manual Part I, section 2302.8 and PRM II to ensure ancillary costs and charges are being reported in the correct cost centers on the cost report. You will want to review these sections to ensure you are complying with CMS requirements and make sure you are reporting your revenue codes appropriately.

To view the transmittal, go to: R1599CP.pdf

Hooper Cornell Healthcare is proud to announce and invites you to attend their 2009 Professional Coding Course. This new coding curriculum is designed to give attendees an understanding of all aspects which are integral to coding including reimbursement and compliance. Each week will focus on coding principles through the use of hands-on medical record coding to help attendees achieve the knowledge required to be successful in the workplace.

Attendees may enroll in our on-line course or in our face-to-face classroom setting. Classes begin January 19, 2009 and meet Monday evenings from 6-9pm. The last class is scheduled through July 27, 2009. The cost is $1800.

Applicants must register by November 1, 2008.

For more information or to register, please contact Amy or Sarah by phone at 208-344-2527 or email hcare@hoopercornell.com.

CMS has announced the names of the new national RACs.  They are:

· Diversified Collection Services, Inc. of Livermore, California, in Region A, initially working in Maine, New Hampshire, Vermont,  Massachusetts, Rhode Island and New York.

· CGI Technologies and Solutions, Inc. of Fairfax, Virginia, in Region B, initially working in Michigan, Indiana and Minnesota.

· Connolly Consulting Associates, Inc. of Wilton, Connecticut, in Region C, initially working in South Carolina, Florida, Colorado and New Mexico.

· HealthDataInsights, Inc. of Las Vegas, Nevada, in Region D, initially working in Montana, Wyoming, North Dakota, South Dakota, Utah and Arizona.

Additional states will be added to each RAC region in 2009.  The program will expand to all 50 states by 2010.

To read more, go to: RAC ExpansionStrategy

CMS has published a list of their most common medically unbelievable edits.  Additional edits will be published January 1, 2009 and at the beginning of each quarter thereafter.  Providers and facilities should implement procedures to identify these MUEs prior to billing to improve the accuracy of claims payments.  Providers are encouraged to review the edits and comment if you believe an edit should be modified.

The reconsideration procedure is described in the MUE FAQ # 8740 (see link below). The list of MUEs can also be accessed at the following link: 08_MUE

The Office of Inspector General has issued its 2009 Work Plan. The workplan includes:

·  Provider Based Status

·  Never Events

·  Place of Service Errors

·  Unbundling of Laboratory Services

·  Payment for Unlisted Procedure Codes

·  Physical Therapy Services

To read the 2009 Workplan in it’s entirety go to: OIGWorkPlanFY2009