June 1, 2012
Will Your Claims Survive the Automated Ordering and Referring NPI Edits?
By: Donna J. Senft
The April 27, 2012 Federal Register publication, Medicare and Medicaid Programs; Changes in Provider and Supplier Enrollment, Ordering and Referring, and Documentation Requirements; and, Changes in Provider Agreements [PDF], contained the final regulations related to the ordering and referring of certain Medicare-covered items and services. For additional background information on this CMS initiative, including the provisions of the May 5, 2010 Interim Final Rule, refer to the article "Requirement to Have a Current Approved PECOS Record." CMS determined these requirements were necessary to ensure physicians and other eligible professionals who order and refer certain items or services have an approved Medicare enrollment record.
In the final rule, CMS reiterated the July 6, 2010 effective date for the requirement to have the NPI number of the ordering or referring physician or non-physician practitioner on the claim. And, CMS clarified that compliance is based on the date of service, not the date of the order or referral. The specific services that are subject to this requirement were modified slightly in the final rule and are: DMEPOS items and services, imaging services, clinical laboratory services, and home health services. Specialist services that had been included in the Interim Final Rule were removed from the final requirements.Click to continue...
HHS Evaluates Independent Living Options
By: Sarah E. Swank
The Department of Health and Human Services (HHS) announced several initiatives under the Affordable Care Act (ACA) that provide services and support to beneficiaries who would otherwise be confined to nursing homes or other institutions. These initiatives focus on either home-based or community-based solutions to ensure independence at home, while evaluating the quality of life and cost effectiveness of such care and services.
- Community First Choice Final Rule. Community First Choice is a new Medicaid plan option under the ACA. Under the final rule [PDF], states choosing to participate in this option will receive a 6% increase in federal Medicaid matching funds. Services will include home and community-based attendant services and support to assist beneficiaries in accomplishing the following: