John Moody's Lab Compliance Issues Page

John Moody's
Healthcare Compliance Issues Page
(Last Updated 06/26/01 at 8:10 a.m.)

Table of Contents

Outpatient Prospective Payment System (OPPS; APC)

HIPAA Information

Hospital Compliance Issues

Laboratory Compliance Issues

Non-Laboratory Coverage Issues - NEW SECTION

Other Resources on the Web

Additional Healthcare Compliance Links

APC OUTPATIENT PROSPECTIVE PAYMENT SYSTEM INFORMATION
HCFA OPPS Quick Reference Guide HCFA OPPS Main Page Medicare Learning Network - OPPS Q/As Medicare Learning Network - OPPS Device Q/As Medicare Learning Network - OPPS Provider-Based Issues Q/As A-01-73 July 2001 Update to the Hospital OPPS 6/1/01 A-01-71 Medicare Transitional Pass-Through Payments Under the Hospital OPPS for Pacemakers and Neurostimulators 5/25/01 A-01-66 July Outpatient Code Editor (OCE) Specifications Version (V2.2) 5/25/01 Update of Calendar Year 2001 Hospital Outpatient Payment Rates and Coinsurance Amounts Effective April 1, 2001 (Excel Spreadsheet) 5/04/01 A-01-51 Calculating Payment-to-Cost Ratios (PCR) for Purposes of Determining Transitional Corridor Payments Under the OPPS and Revising the Criteria Under Which a Provider May Request a Recalculation of Its Cost-to-Charge Ratio 4/13/01 A-01-50 Further Guidance Regarding Billing Under the Outpatient Prospective Payment System (OPPS) 4/12/01 A-01-41 Categories for Use in Coding Devices Eligible for Transitional Pass-Through Payments Under OPPS 1/23/01 A-01-40 Additional Information on Transitional Pass-Through Devices and Drugs 1/23/01 A-01-17 Impact of the Benefits Improvement and Protection Act on Devices Eligible for Transitional Pass-Through Payments Under the Hospital Outpatient Prospective Payment System 1/31/01 ARC Reimbursement Update - OPPS Billing Guidance April 2001 Downloadable PowerPoint file 5/18/01 A-01-10 Technical Corrections to the January 2001 Update: Coding Information for Hospital OPPS 1/16/01 A-01-01 January Outpatient Code Editor (OCE) Specifications Version (V2.0) 1/16/01 A-00-102 Hospital Outpatient Prospective Payment System Pass-Through Payment Corrections for Two Radiopharmaceuticals 12/29/00 Reporting of OPPS and Home Health Prospective Payment System (HH PPS) Data in Provider Remittance Advice Transactions 12/21/00 A-00-82 January 2001 Update: Coding Information for Hospital OPPS (See A-01-10 above for corrections.) 11/3/00 PPS for Hospital Outpatient Services for Calendar Year 2001 11/2/00 A-00-80 Notification to Outpatient Hospital Service Providers Concerning Deductible and Coinsurance Amounts on Electronic Remittance Advice Version 3051.4a 10/31/00 A-00-72 Technical Corrections to Coding Information for Hospital OPPS 10/03/00 A-00-63 Cost-to-Charge Ratios (CCRs) for Calculating Certain Payments Under the Hospital OPPS 9/08/00 A-00-61 Update 1--Coding Information for Hospital OPPS 9/06/00 Important Notice of OPPS Implementation Progress 8/22/00 A-00-53 Proper Billing of Units for Intrathecal Baclofen under OPPS 8/16/00 A-00-45 Interim Process for Certain "Inpatient Only" Code Changes 8/2/00 New List of Drugs, Biologics, Devices, and New Technology Services for OPPS 7/28/00 A-00-44 Outpatient Prospective Payment System Contingency Plans and Instructions 7/28/00 New OPPS Device Information (file) 7/27/00 A-00-40 Further Information on the Use of Modifier -25 in Reporting Hospital Outpatient Services 7/20/00 MSB-00-02 Medicare Special Bulletin A2000-2 OPPS Implementation Instructions 5/8/00 Prospective Payment System Final Rule 3/31/00

APC OUTPATIENT PROSPECTIVE PAYMENT SYSTEM INFORMATION

Medicare Learning Network - OPPS Device Q/As

Medicare Learning Network - OPPS Provider-Based Issues Q/As

A-01-73 July 2001 Update to the Hospital OPPS

6/1/01

A-01-71 Medicare Transitional Pass-Through Payments Under the Hospital OPPS for Pacemakers and Neurostimulators

5/25/01

A-01-66 July Outpatient Code Editor (OCE) Specifications Version (V2.2)

5/25/01

Update of Calendar Year 2001 Hospital Outpatient Payment Rates and Coinsurance Amounts Effective April 1, 2001 (Excel Spreadsheet)

5/04/01

A-01-51 Calculating Payment-to-Cost Ratios (PCR) for Purposes of Determining Transitional Corridor Payments Under the OPPS and Revising the Criteria Under Which a Provider May Request a Recalculation of Its Cost-to-Charge Ratio

4/13/01

A-01-50 Further Guidance Regarding Billing Under the Outpatient Prospective Payment System (OPPS)

4/12/01

A-01-41 Categories for Use in Coding Devices Eligible for Transitional Pass-Through Payments Under OPPS

1/23/01

A-01-40 Additional Information on Transitional Pass-Through Devices and Drugs

1/23/01

A-01-17 Impact of the Benefits Improvement and Protection Act on Devices Eligible for Transitional Pass-Through Payments Under the Hospital Outpatient Prospective Payment System

1/31/01

ARC Reimbursement Update - OPPS Billing Guidance April 2001 Downloadable PowerPoint file

5/18/01

A-01-10 Technical Corrections to the January 2001 Update: Coding Information for Hospital OPPS

1/16/01

A-01-01 January Outpatient Code Editor (OCE) Specifications Version (V2.0)

1/16/01

A-00-102 Hospital Outpatient Prospective Payment System Pass-Through Payment Corrections for Two Radiopharmaceuticals

12/29/00

Reporting of OPPS and Home Health Prospective Payment System (HH PPS) Data in Provider Remittance Advice Transactions

12/21/00

A-00-82 January 2001 Update: Coding Information for Hospital OPPS (See A-01-10 above for corrections.)

11/3/00

PPS for Hospital Outpatient Services for Calendar Year 2001

11/2/00

A-00-80 Notification to Outpatient Hospital Service Providers Concerning Deductible and Coinsurance Amounts on Electronic Remittance Advice Version 3051.4a

10/31/00

A-00-72 Technical Corrections to Coding Information for Hospital OPPS 10/03/00

A-00-63 Cost-to-Charge Ratios (CCRs) for Calculating Certain Payments Under the Hospital OPPS 9/08/00

A-00-61 Update 1--Coding Information for Hospital OPPS 9/06/00

Important Notice of OPPS Implementation Progress 8/22/00

A-00-53 Proper Billing of Units for Intrathecal Baclofen under OPPS

8/16/00

A-00-45 Interim Process for Certain "Inpatient Only" Code Changes 8/2/00

New List of Drugs, Biologics, Devices, and New Technology Services for OPPS 7/28/00

A-00-44 Outpatient Prospective Payment System Contingency Plans and Instructions

7/28/00

New OPPS Device Information (file) 7/27/00

A-00-40 Further Information on the Use of Modifier -25 in Reporting Hospital Outpatient Services 7/20/00

MSB-00-02 Medicare Special Bulletin A2000-2 OPPS Implementation Instructions 5/8/00

Prospective Payment System Final Rule 3/31/00

HIPPA INFORMATION
Final Rule: Standards for Privacy of Individually Identifiable Health Information 12/28/00 Protecting the Privacy of Patients'Health Information: Summary of the Final Regulation 12/20/00 Final Rule: HIPAA Standards for Electronic Transactions (Compliance Date is 26 months) 8/16/00 HCFA HIPPA On-Line Web Site 01/02/00 Technical corrections to the final rule 11/24/00 HHS HIPAA Administration Simplification Web Page 8/16/00 Health Hippo Web Site (HIPAA News, FAQs, HIPAA Law) HIPAAdvisory Web Site - Phoenix Health Systems' Site for HIPAA Information 4/27/01 HIPAA Administrative Simplification Code Sets 6/8/01

HIPPA INFORMATION

LABORATORY COMPLIANCE ISSUES
Local Medical Review Policies Updated 06/26/01 Medical Necessity of Laboratory Test A-00-43: Advance Beneficiary Notices (ABNs) for Services for Which Institutional Part B Claims Will be Processed by Fiscal Intermediaries 7/27/01 AB-01-47 Independent Laboratory Billing for the Technical Component (TC) of Physician Pathology Services to Hospital Patients 3/22/01 Screening Pap Smear and Screening Pelvic Examinations Update 03/19/01 Colorectal Screening Update 03/19/01 Medicare Hospital Manual Transmittal 769 Changes in Colorectal Billing Effective 7/1/01 2/13/00 Payment for Blood Clotting Factor Administered to Hemophilia Inpatients - Correction 2/5/01 ARC Newsletter - Blood Product Billing under OPPS - Download PowerPoint file (Exhibit C Update to follow) 1/24/01 AB-00-134 Cervical or Vaginal Smear Tests (Pap Smears) in Calendar Year (CY) 2001 Clinical Diagnostic Laboratory Fee Schedule 12/29/00 Medicare Special Bulletin AB2000-05: 2001 CPT Code Changes 12/01/00 AB-00-108 Glucose Monitoring 12/01/00 Proposed rule requiring hospitals that transfuse blood and blood products to prepare and follow written procedures for appropriate action when it is determined that blood and blood products the hospitals received and transfused are at increased risk for transmitting hepatitis C virus (HCV)) 11/16/00 Medicare Hospital Manual Transmittal # 758 Prostrate Cancer Screening Tests and Procedures 7/28/00 Proposed Rules: Clinical diagnostic laboratory services; coverage and administrative policies; negotiated rulemaking 3/10/00 OIG Advisory Opinion No. 99-13 - re: Pathology Account Billing12/08/99 College of American Pathologist (CAP) LAP Checklist_6/99 Prostate Cancer Screening Tests6/99 Coverage of Testing for Hepatitis C in Patients Exposed to Infected Blood_6/99 Requirements for Principal Diagnosis on Outpatient Billing Reminder - Part A5/99 BBA97 Section Requiring Physicians to Provide Diagnosis Information OIG Clinical Laboratory Model Compliance Plan (8/98 version) OIG Clinical Laboratory Model Compliance Plan (3/97 version) Medicare Travel Allowance Fees for Collection of Specimens FDA Final Rule to Classify/Reclassify Analyte Specific Reagents (ASR) College of American Pathologist (CAP) Facts on ASRs FDA Final Rule to Classify/Reclassify Immunohistochemistry (IHC) Reagents Retention of Health Information

LABORATORY COMPLIANCE ISSUES

NON-LABORATORY COVERAGE ISSUES
HCFA Medicare Coverage Policy ~ Decisions 1/25/01 Medicare Coverage of Clinical Trials: Medicare Learning Network: Coverage of Clinical Trial Services Q/A 4/26/01 Medicare Coverage Policy ~ Clinical Trials 11/27/00 FDA Clinical Trials Website 11/27/00 Liver Transplantation for Patients with Malignancies (#CAG-00091A) 5/22/01

HOSPITAL COMPLIANCE ISSUES
HCFA Fiscal Year 2002 proposed rule for changes to the Medicare inpatient PPS 5/4/01 AB-01-65 Procedures Subject to Home Health Consolidated Billing 4/26/01 New regulations governing the reprocessing of single-use devices (SUDs): 4/23/01 FDA follow-up letter to hospitals laying out agency's timetable for enforcement Reuse of Single Use Devices Home Page (Resource for SUDs issues) A-01-52 Medicare Payment for Ambulance Services Furnished by Certain Critical Access Hospitals (CAH) 4/16/01 AB-01-60 New Temporary �Q� Codes for Splints and Casts Used for Reduction of Fractures and Dislocations 4/12/01 A-01-39 Postacute Care Transfer Policy 3/22/01 Medicare Hospital Manual Transmittal 769 Changes in Colorectal Billing Effective 7/1/01 2/13/01 Medicare Program; Payment for Nursing and Allied Health Education; Final Rule _1/12/01 Medicaid Program; Revision to Medicaid Upper Payment Limit Requirements for Hospital Services, Nursing Facility Services, Intermediate Care Facility Services for the Mentally Retarded, and Clinic Services; Final Rule _1/12/01 Stark II (Phase I): Physicians' Referrals to Health Care Entities With Which They Have Financial Relationships (HCFA-1809-FC) _1/02/2001 Physicians' Referral FAQ _1/16/2001 PM Transmittal AB-00-131: Clarifications to Implementation of the Ambulance Fee Schedule _10/02/2000 HHS/OIG FY2001 Work Plan for HCFA (.pdf format) _10/02/2000 New Ambulance Fee Schedule _9/18/2000 OIG Special Fraud Alert: Rental of Space in Physician Offices by Persons or Entities to Which Physicians Refer_2/23/00 OIG Special Fraud Alert: Physician Liability for Certifications in the Provision of Medical Equipment, Supplies and Home Health Services_1/7/2000 Fact Sheet: Federal Anti-Kickback Law and Regulatory Safe Harbors_11/19/1999 HHS-OIG Special Advisory Bulletin: Patient Anti-Dumping - 11/10/1999 Medicare Secondary Payor Questionnaire _11/09/1999 HHS/OIG FY2000 Work Plan for HCFA (.pdf format)_10/11/1999 HHS-OIG Special Advisory Bulletin:Effects of Exclusion... - 9/28/1999 LMRP - Outpatient Observation Room Services_9/99 OIG Program Exclusion Authorities_9/29/1999 OIG letter concerning hospital-physician incentive plans for Medicare and Medicaid beneficiaries enrolled in managed care plans_8/25/1999 Inpatient Prospective Payment System Changes for 2000_8/2/1999 Revised OIG Sanctions Authority Effective 7/22/1999 OIG Special Advisory Bulletin: Gainsharing Arrangements and CMPs for Hospital Payments to Physicians to Reduce or Limit Services to Beneficiaries_7/8/1999 OIG Draft Compliance Guidance to Managed Care Organizations Participating in Medicare_6/24/1999...FR 6/24/1999 Notice HCFA Tramsmittal of Instructions to FIs/Carriers for Handling Unsolicited/Voluntary Refunds_5/21/1999 Beneficiary Right to Itemized Statement for Medicare Items and Services SHARING BIOMEDICAL RESEARCH RESOURCES: Principles and Guidelines for Recipients of NIH Research Grants and Contracts OIG Hospital Model Compliance Plan (.pdf format) Ambulatory Surgery Center Payment Policy Changes HCFA Proposed Rule Changes to Conditions of Participation Discussion of Proposed Stark II Regulations The False Claims Act HHS-OIG Excluded/Sanction Providers Web Page OIG's Provider Self-Disclosure Protocol (.pdf format) Proposed OIG/HCFA Advisory Opinion Regarding Anti-Patient Dumping Statutes and obligations of Hospitals regarding screening emergency services patients without asking patient to sign ABN prior to treatment.

HOSPITAL COMPLIANCE ISSUES

A-01-52 Medicare Payment for Ambulance Services Furnished by Certain Critical Access Hospitals (CAH)

4/16/01

AB-01-60 New Temporary �Q� Codes for Splints and Casts Used for Reduction of Fractures and Dislocations

4/12/01

A-01-39 Postacute Care Transfer Policy

3/22/01

Medicare Hospital Manual Transmittal 769 Changes in Colorectal Billing Effective 7/1/01

2/13/01

Medicare Program; Payment for Nursing and Allied Health Education; Final Rule _1/12/01

Medicaid Program; Revision to Medicaid Upper Payment Limit Requirements for Hospital Services, Nursing Facility Services, Intermediate Care Facility Services for the Mentally Retarded, and Clinic Services; Final Rule _1/12/01

Stark II (Phase I): Physicians' Referrals to Health Care Entities With Which They Have Financial Relationships (HCFA-1809-FC) _1/02/2001 Physicians' Referral FAQ _1/16/2001

PM Transmittal AB-00-131: Clarifications to Implementation of the Ambulance Fee Schedule _10/02/2000

HHS/OIG FY2001 Work Plan for HCFA (.pdf format)

_10/02/2000

New Ambulance Fee Schedule

_9/18/2000

OIG Special Fraud Alert: Rental of Space in Physician Offices by Persons or Entities to Which Physicians Refer_2/23/00

OIG Special Fraud Alert: Physician Liability for Certifications in the Provision of Medical Equipment, Supplies and Home Health Services_1/7/2000

Fact Sheet: Federal Anti-Kickback Law and Regulatory Safe Harbors_11/19/1999

HHS-OIG Special Advisory Bulletin: Patient Anti-Dumping - 11/10/1999

Medicare Secondary Payor Questionnaire _11/09/1999

HHS/OIG FY2000 Work Plan for HCFA (.pdf format)

_10/11/1999

HHS-OIG Special Advisory Bulletin:Effects of Exclusion... - 9/28/1999

LMRP - Outpatient Observation Room Services_9/99

OIG Program Exclusion Authorities_9/29/1999

OIG letter concerning hospital-physician incentive plans for Medicare and Medicaid beneficiaries enrolled in managed care plans_8/25/1999

Inpatient Prospective Payment System Changes for 2000_8/2/1999

Revised OIG Sanctions Authority Effective 7/22/1999

OIG Special Advisory Bulletin: Gainsharing Arrangements and CMPs for Hospital Payments to Physicians to Reduce or Limit Services to Beneficiaries_7/8/1999

OIG Draft Compliance Guidance to Managed Care Organizations Participating in Medicare_6/24/1999...FR 6/24/1999 Notice

HCFA Tramsmittal of Instructions to FIs/Carriers for Handling Unsolicited/Voluntary Refunds_5/21/1999

Beneficiary Right to Itemized Statement for Medicare Items and Services

SHARING BIOMEDICAL RESEARCH RESOURCES: Principles and Guidelines for Recipients of NIH Research Grants and Contracts

OIG Hospital Model Compliance Plan (.pdf format)

Ambulatory Surgery Center Payment Policy Changes

HCFA Proposed Rule Changes to Conditions of Participation

Discussion of Proposed Stark II Regulations

The False Claims Act

HHS-OIG Excluded/Sanction Providers Web Page

OIG's Provider Self-Disclosure Protocol (.pdf format)

Proposed OIG/HCFA Advisory Opinion Regarding Anti-Patient Dumping Statutes and obligations of Hospitals regarding screening emergency services patients without asking patient to sign ABN prior to treatment.

OTHER RESOURCES ON THE INTERNET:
GPO Access (Federal Register) Alabama Medicare (Provider Page) MedicareFocus (AL) Medicare Special Bulletins MSB2000-5 has 2001 CPT Updates! Today in Health Law (American Health Lawyers Assoc.) Document from Government-IndustryRoundtable co-sponsored by the OIG and the Health Care ComplianceAssociation (Interesting Info!!!) HHS-OIG Advisory Opinions (Advisory Opinions No. 01-06 Posted 5/29/01) Medicare/Medicaid Program Memos OIG Anti-Kickback Information Medicare's Program Integrity Home Page HCFA Home Page HHS-OIG Home Page Medicaid of Alabama Links Source for Medicare/Medicaid Manuals, Transmittals and Memos ICD9 Code Listing Washington G-2 Reports Health Watch Newsletter

OTHER RESOURCES ON THE INTERNET:

GPO Access (Federal Register)
Alabama Medicare (Provider Page)
MedicareFocus (AL)
Medicare Special Bulletins MSB2000-5 has 2001 CPT Updates!
Today in Health Law (American Health Lawyers Assoc.)

Document from Government-IndustryRoundtable co-sponsored by
the OIG and the Health Care ComplianceAssociation (Interesting Info!!!)
HHS-OIG Advisory Opinions (Advisory Opinions No. 01-06 Posted 5/29/01)
Medicare/Medicaid Program Memos
OIG Anti-Kickback Information
Medicare's Program Integrity Home Page
HCFA Home Page
HHS-OIG Home Page
Medicaid of Alabama Links
Source for Medicare/Medicaid Manuals, Transmittals and Memos
ICD9 Code Listing
Washington G-2 Reports
Health Watch Newsletter

Additional Healthcare Compliance Links

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