This month, the American Medical Association (AMA) published the 2013 edition of the CPT codebook. The AASM is excited to announce that CPT 2013 includes two new codes for pediatric polysomnography.

On Tuesday, Oct. 2, the Office of the Inspector General (OIG) published their Work Plan for 2013. The OIG Work Plan describes activities the OIG will initiate or continue throughout the year. Through its activities, the OIG seeks to fight waste, fraud and abuse in the US Department of Health and Human Services (HHS) programs such as Medicare.

On Oct. 1, the Centers for Medicare & Medicaid Services (CMS) implemented two new programs under the Affordable Care Act. The Hospital Value-Based Purchasing Program emphasizes quality of care in the hospital setting by shifting toward a pay-for-performance model. Under the new program, Medicare will withhold 1 percent of reimbursements to acute-care hospitals and redistribute these funds to hospitals that meet high performance standards.

On Sept. 21 a bill was introduced in the House of Representatives that would replace the Medicare DMEPOS competitive bidding program with market pricing.

Two new reports from the Office of the Inspector General (OIG) and The Center for Public Integrity show that billing trends over the past 10 years reflect a steady increase in billing Medicare for higher paying services. This trend was shown to be particularly prevalent in the billing of established patient office visit codes.

In late August, the Centers for Medicare & Medicaid Services (CMS) published a final rule specifying the stage 2 criteria for the Electronic Health Record (EHR) incentive program. The incentive program provides substantial incentive payments to health care professionals and hospitals that adopt and meaningful use certified EHR technology.

Last month, AASM staff contact UHC regarding their new process for Advanced Notification and Prior Authorization Requirements for Polysomnography and Portable Monitoring for Sleep Related Breathing Disorders. In discussions with the AASM, UHC has confirmed details of the process.

CGS, the DME Medicare Administrative Contractor (MAC) in Jurisdiction C has developed a denial aid website in an effort to clarify documentation requirements and assist suppliers in understanding denials. The website lists categories of denials for PAP devices. The categories expand to include all possible denials associated with that category. For each denial, the associated documentation requirements are listed. References, including links to complete reference documents, are also included.

On Friday, Aug. 24, the Centers for Medicare & Medicaid Services (CMS) published a final rule extending the compliance date for ICD-10 from Oct. 1, 2013 to Oct. 1, 2014.

In early August, AASM members across the country were contacted by UnitedHealthcare (UHC) regarding their new process for Advanced Notification and Prior Authorization Requirements for Polysomnography and Portable Monitoring for Sleep Related Breathing Disorders. The new process promotes the use of out of center sleep testing (OCST) and establishes an advance notification and/or prior authorization requirement for all in-center sleep testing.