Health Industry Washington Watch : Washington DC Healthcare Industry Law Firm : Reed Smith : Health Industry Washington Watch : Regulations, Medicare/Medicaid, Governmental Organizations

CMS will host a follow-up national provider conference call on "ICD-10 Implementation in a 5010 Environment" on September 13, 2010.  The call is intended for medical coders, physician office staff, provider billing staff, health records staff, vendors, educators, system maintainers, and all Medicare fee-for-service providers. The call will cover:  ICD-10; ICD-10 implementation for services provided on and after October 1, 2013; differences between ICD-10 and ICD-9-CM codes; ICD-10-CM basic information for all users; tools for converting codes – General Equivalence Mappings (GEMs); proposal to freeze ICD-9-CM and ICD-10 code updates except for new technologies and diseases; HIPAA Version 5010; compliance dates and timelines; 5010 before and after ICD-10 implementation; readiness review for implementing HIPAA version 5010 and D.0; how to prepare; and Medicare fee-for-service activities update. The registration deadline is September 10 or when space is filled. 

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The ICD-9-CM Coordination and Maintenance Committee will meet September 15-16, 2010 to receive public input on the crosswalk between the Ninth and Tenth Revisions of the International Classification of Diseases (ICD-9 and ICD-10, respectively). 

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CMS is hosting a national provider conference call June 15, 2010 on "ICD-10 Implementation in a 5010 Environment.” The target audience for the call is medical coders, physician office staff, provider billing staff, health records staff, vendors, educators, system maintainers, and all Medicare fee-for-service providers. The following topics will be discussed:

• ICD-10:  ICD-10 implementation for services provided on and after October 1, 2013; Benefits of ICD-10; Differences between ICD-10 and ICD-9-CM codes; Tools for converting codes – General Equivalence Mappings; Proposal to freeze ICD-9-CM and ICD-10 code updates except for new technologies and diseases
• HIPAA Version 5010: General Overview HIPAA version 5010 and D.0 and who is impacted; Compliance dates; Benefits; 5010 scope versus ICD-10 Scope; What you need to do to prepare; timelines; Medicare FFS implementation of HIPAA version 5010 and D.0; Impact on paper claim forms.

Registration for the call closes on June 14.

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On March 23, CMS is hosting a National Provider Conference Call on the ICD-10-CM/PCS coding system. Topics to be covered include: the requirement use ICD-10-CM/PCS codes for services provided on or after October 1, 2013; a comparison of the ICD-9-CM and ICD-10-CM; common ICD-10-CM myths and misperceptions; and the impact of ICD-10-CM on medical record documentation.

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CMS has announced the dates for the 2010 Healthcare Common Procedure Coding System (HCPCS) public meetings, at which the agency will discuss its preliminary coding and payment determinations for all new public requests for revisions to the HCPCS. On May 4-5, CMS will review applications for codes for Drugs/Biologicals/Radiopharmaceuticals/Radiologic Imaging Agents; the May 25-26 sessions will review applications for Supplies; on May 27 CMS will focus on Orthotics and Prosthetics codes; and the June 8 session will review Durable Medical Equipment and Accessories coding applications. Draft agendas, including CMS' preliminary decision, will be posted on the HCPCS website at least 4 weeks before each meeting. 

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On November 19, 2009, CMS is hosting a provider conference call on the ICD-10-CM/PCS Medicare Severity-Diagnosis Related Group Conversion Project. The call will discuss how CMS uses the General Equivalence Mappings (GEM) tool to convert ICD-9-CM data or payment systems to the relevant ICD-10-CM/PCS codes. The registration deadline for the call is November 18.

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On November 2, 2009, CMS posted the 2010 update to the Healthcare Common Procedure Coding System (HCPCS) code set.  

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CMS is accepting applications for the 2011 Healthcare Common Procedure Coding System (HCPCS) update. Completed applications must be received by CMS by January 4, 2010.

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On July 9, 2009, CMS is holding meetings to discuss preliminary determinations on public requests for HCPCS codes for negative pressure wound therapy (NPWT) devices.  CMS has tentatively decided not to establish new coding for NPWT systems/components, citing a technology assessment  that found that the available evidence does not support significant therapeutic distinction of a NPWT system or component of a system.

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CMS has released the 2011 HCPCS update application form and instructions. To be considered for inclusion in the year 2011 HCPCS update, completed recommendation packets must be received by the close of business on Monday, January 4, 2010.

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CMS is hosting an ICD-10-CM/PCS Implementation and General Equivalence Mappings National Provider Conference Call on May 19, 2009. This call will include a discussion of the following topics:

• An overview of the ICD-10 final rule, which requires the implementation of ICD-10-CM/PCS on October 1, 2013;
• The differences between ICD-9-CM and ICD-10-CM/PCS codes;
• The use of the General Equivalence Mappings that have been created to assist in converting policies, edits, and trend data from ICD-9-CM to ICD-10-CM/PCS; and
• Resources to assist in planning for the transition from ICD-9-CM to ICD-10-CM/PCS.

Conference call discussion materials and registration information will be available on the CMS website.

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The Obama Administration has been reviewing regulations issued late in the Bush Administration, including HHS final rules published January 16, 2009 that mandate the use of updated diagnosis and procedure codes (the ICD-10-CM rule) and updated standards for electronic health care and pharmacy transactions under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The Administration has decided not to delay implementation of these final rules or reopen the rules for comment.

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On March 11-12, 2009 the ICD-9-CM Coordination and Maintenance Committee is holding a public forum to discuss proposed changes to ICD-9-CM. The first day of the meeting will be devoted to procedure code issues, while the second day will concentrate on diagnosis code issues. The registration deadline is March 5, 2009.

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On February 27, 2009, CMS published a notice announcing the dates for the 2009 Healthcare Common Procedure Coding System (HCPCS) public meetings to discuss CMS’s preliminary coding and payment determinations for public requests for revisions to the HCPCS, including dates to consider new drug code requests.  The meeting dates are as follows: 

April 28, 2009: Drugs/Biologicals/Radiopharmaceuticals/Radiologic Imaging Agents (CMS notes that the April 29 date is tentative and may not be needed)

May 12 - 13, 2009: Supplies and Other Items

May 27, 2009: Orthotics and Prosthetics

May 28, 2009: Durable Medical Equipment (DME) and Accessories

July 9, 2009: DME and Accessories, including Negative Pressure Wound Therapy (NPWT) devices.

The notice outlines deadlines for primary speakers and other attendees. Draft agendas, including a summary of each request and CMS’s preliminary decision, will be posted on the CMS website at least 4 weeks before each meeting.

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The Department of Health and Human Services (HHS) published a final rule on January 16, 2009 adopting new code sets to be used by the public and private sectors for reporting diagnoses and inpatient procedures in health care transactions under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).  Specifically, the rule adopts the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD–10–CM) for diagnosis coding, and the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD–10–PCS) for inpatient hospital procedure coding. These codes replace the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD–9–CM) Volumes 1 and 2, and the International Classification of Diseases, Ninth Revision, Clinical Modification Volume 3 for diagnosis and procedure codes, respectively. HHS notes that the shortcomings of the current ICD-9 system include limited ability to accommodate new procedures and diagnoses; lack of specificity and detail; inconsistent terminology, and lack of codes for preventive services. On the other hand, HHS expects adoption of the ICD-10 code set to support value-based purchasing and reporting of quality data and ensure more accurate payments for new procedures. While HHS believes the new systems will result in significant long-term savings, short-term implementation costs (training, productivity losses, and systems changes) could reach almost $2 billion. The rule is effective October 1, 2013, two years later than provided in the August 22, 2008 proposed rule. 

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Applications for new or revised Healthcare Common Procedure Coding System (HCPCS) codes for the 2010 update are due January 5, 2009. 

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CMS has released the 2009 update of the Healthcare Common Procedure Coding System (HCPCS) code set.

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CMS has released most of its “Medically Unlikely Edits” (MUE), which are used by Medicare contractors when processing claims to ensure that providers and suppliers do not report excessive services.   An MUE for a HCPCS/CPT code is the maximum units of service under most circumstances that a provider would report for a code for a single beneficiary on a single date of service; claims with more than the MUE edit amount will be denied (unless a modifier is used to used to report medically necessary units of service in excess of an MUE value).   The MUE currently contains edits for about 9,700 HCPCS/CPT codes, although CMS is not publishing all active MUEs since it could diminish the effectiveness of MUE edits that are designed to detect and deter questionable payments rather than billing errors. CMS will update the list quarterly. 

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CMS will host a series of national provider calls regarding issues associated with the adoption of the ICD-10 coding system. Separate calls are scheduled for hospital staff (October 14), other Part A and Part B providers (November 12), and physicians (November 17). Call details, including registration information and CMS’s slide presentation, are available on the CMS web site. 

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