Medicare Changes Mean Billing Changes

HDM Breaking News, November 18, 2009

A Medicare initiative to better calculate fee-for-service payment error rates will result in new billing procedures for hospitals. The program also is reporting a much higher error rate than in past years.

The Centers for Medicare and Medicaid services has revamped how it reviews Medicare claims for inpatient hospital services and has eliminated the use of past billing records as part of a complex medical review. The result of heightened scrutiny and a more complete accounting of fee-for-service claims is that Medicare's 2009 FFS error rate was 7.8%, compared with 3.6% in 2008, according to CMS. Consequently, the agency is taking a number of steps to ensure:

* providers are submitting all required clinical and medical documents to support a claim,
* providers' signatures on medical documents are legible,
* providers' claims histories can no longer be used to fill in missing treatment documentation, and
* medical information from a health care provider must be included to support durable medical equipment claims, in addition to records from suppliers.

More information is available at https://www.cms.hhs.gov/apps/media/press_releases.asp and https://www.cms.hhs.gov/apps/media/fact_sheets.asp.

--Joseph Goedert

For more information on related topics, visit the following channels:

• Coding
• Electronic Data Interchange
• Electronic Health Records
• Practice Management
• Revenue Cycle Management
• Hospitals
• Group Practices
• Payers