Clinical Resources Articles
These sleep medicine articles include updates about coding and reimbursement, new practice guidelines, and telemedicine. To view our case study of the month, visit the AASM sleep medicine case studies page.
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.
The federal health reform law will arm Medicare anti-fraud teams with sophisticated tools and funding to better identify individuals seeking to profit from the program.
In an Aug. 20 news release, Aetna and Coventry Health Care Inc. announced an agreement under which Aetna will acquire Coventry in a transaction which is valued at $7.3 billion. As a result of the agreement, Aetna is expected to add over 5 million total members across their commercial businesses, Medicare Part D, Medicare advantage and Medicaid. It is estimated that the acquisition will close in mid-2013.
The Centers for Medicare & Medicaid Services (CMS) has announced that registration is open to suppliers interested in participating in Round 1 of the Recompete of the Medicare DMEPOS Competitive Bidding Program. The Competitive Bidding Program was mandated by Congress in 2003. It requires that current fee schedule methodology be replaced with a competitive bid process. Under this process, suppliers operating a particular competitive bidding area (CBA) submit bids for products. View the full article to find which competitive bidding areas are included in the recomplete.