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Nursing Home News, Oct. 15, 2015 Vol 22 Issue 23
Nursing Home News

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Vol. 22 Issue 23


Use ICD-10 Now: Here’s How – On October 1 the United States health care community transitioned to ICD-10. CMS wants providers to be successful in using ICD-10 and remains committed to working with industry on the transition. To give providers a quick reference, CMS has posted the Use ICD-10 Now infographic on their website.

Coding Claims: When to Use ICD-10 versus ICD-9

Use of ICD-10 versus ICD-9 on claims is based on dates of service—not on dates that claims are submitted.
  • For dates of service before October 1, 2015, use ICD-9 codes.
  • For dates of service on or after October 1, 2015, use ICD-10 codes.
For example, if you submit a claim for services provided on September 30, 2015, use ICD-9, even if you are submitting the claim in October 2015 or beyond.

For hospital inpatient claims, use date of discharge rather than date of service to determine whether to code in ICD-10 or ICD-9.

Important Note about Physician Orders

For orders written with ICD-9 codes before October 1, CMS is not requiring the ordering provider to rewrite the original order with the appropriate ICD-10 code for lab, radiology services, or any other services. For more see the new Physician’s Orders FAQ 12625.

Splitting Claims

Many health plans require claims with dates of service spanning October 1 to be split into two claims, one with ICD-9 and the other with ICD-10 codes.

A Medicare fee-for-service (FFS) claim cannot contain both ICD-9 codes and ICD-10 codes. Medicare will not pay claims containing both ICD-9 and ICD-10 codes. CMS has issued guidance for providers dealing with claims spanning the compliance date.

Accessing Codes

See the ICD-10 Coding Resources fact sheet to find out about accessing ICD-10 codes, ICD-9/ICD-10 mappings, and clinical documentation tips.

Other Resources
  • Find the latest resources at the official CMS ICD-10 website.
  • Visit to build a customizable action plan, and to see common codes, documentation tips and clinical scenarios for your specialty.
  • Find additional ICD-10 resources at low or no cost through medical and trade associations.
Keep Up to Date on ICD-10

Visit the CMS ICD-10 website and for the latest news and resources, including the ICD-10 Quick Start Guide. Sign up for CMS ICD-10 Email Updates and follow us on Twitter.

Recent Cases Involving 60-Day Overpayment Rule Should Put Healthcare Providers on Alert (I. Paul Mandelkern, Lowndes, Drosdick, Doster, Kantor & Reed, P.A.) – Two recent federal court cases show that the federal government intends to vigorously enforce the so-called "60-day Rule" for the return of overpayments enacted as part of the Affordable Care Act (the "ACA") even though the Centers for Medicare & Medicaid Services ("CMS") has not yet issued its final interpretative regulation for that rule. Therefore, healthcare providers should put policies and procedures in place now that comply with the 60-day Rule for returning Medicare and Medicaid overpayments to the government.

The 60-day Rule requires a healthcare provider, who has received a Medicare or Medicaid overpayment, to report and return the overpayment within 60 days from the date on which the overpayment was "identified." An "overpayment" is defined in the ACA to mean "any funds that a person receives or retains under [Medicare] or [Medicaid] to which the person, after applicable reconciliation, is not entitled to ... ." The term "identified" is not defined in the ACA. If a provider fails to report and return the overpayment within the required 60-day period it can be subject to substantial liability under the federal False Claims Act. In February of 2012, CMS issued a proposed interpretative regulation regarding the 60-day Rule as it relates to providers under Medicare Parts A and B.

Under the proposed regulation, an overpayment is "identified" when a read the full article, click here.

Quality of Patient Care Star Rating Preview Reports Now Available – The Quality of Patient Care Star Ratings Preview Reports are now available in the CASPER folders. These reports contain data that will be publicly reported on the Home Health Compare (HHC) website in January 2016. The deadline to submit a request to have the star rating data suppressed is October 17, 2015. Please follow the directions laid out in the Preview Reports to submit a suppression request.

The October refresh of the HHC website occurred on October 8th. The data presented on HHC in October were previewed in the reports posted on CASPER in July.

Some providers may see small differences between the measure value displayed on HHC in October and that shown on their preview reports sent out in July, for select measures. This is because measure values were recalculated after the dissemination of the preview reports to include any late or corrected submission received after measure values were initially calculated, for each month during the 12-month reporting period. This recalculation did not affect the Quality of Patient Care star rating, or any of the measures included in its calculation. Going forward, the data tables used to calculate measures for HHC will be updated prior to the dissemination of the preview reports to capture any late or corrected OASIS submissions, and then frozen until display on HHC. Home Health Compare will continue to be updated on a quarterly basis.

Any questions about these reports can be directed to

Acetaminophen Tablets by Medline Industries: Recall - Mislabeling with Incorrect Strength – On October 9, 2015, Medline Industries, Inc. announced that it will initiate a voluntary nationwide recall of lot # 45810 of Acetaminophen tablets, 500mg, uncoated compressed tablets to the consumer level. The Acetaminophen 500mg, Tab 100/BT (OTC20101) has been found to be mislabeled displaying “Acetaminophen 325mg” (OTC10101) instead of “Acetaminophen 500mg”. This error is not easily identifiable by the user or prescriber. If the product is taken at the maximum labeled dose, every four hours, five doses a day, or with other medications containing acetaminophen, it may lead to liver toxicity or liver failure. See the firm Press Release for further details.

Background: Acetaminophen tablets is an over the counter (OTC) oral medication used to temporarily relieve minor aches and pains due to minor pain of arthritis, muscular aches, back aches, headaches, toothaches, the common cold, premenstrual and menstrual cramps, and reduces fever. This item is packaged as 100 tablets per bottle, Medline Item Number: OTC20101, NDC#: 53329-641-30. The recalled Acetaminophen 500mg, Tab 100/BT (OTC20101) includes lot # 45810 with expiration date May 2018. This lot was distributed nationwide from June 12, 2015 through September 18, 2015.

Medline Industries, Inc. notified its distributors, consumers and/or retailer customers by First Class Mail on September 25th, 2015 and is arranging for return and credit of all recalled products. Consumers, distributors, and/or retailers that have product which is being recalled should stop using and return to Medline Industries, Inc.

Healthcare professionals and patients are encouraged to report adverse events or side effects related to the use of these products to the FDA's MedWatch Safety Information and Adverse Event Reporting Program:
  • Complete and submit the report Online:
  • Download form or call 1-800-332-1088 to request a reporting form, then complete and return to the address on the pre-addressed form, or submit by fax to 1-800-FDA-0178.
Read the MedWatch safety alert, including a link to the firm Press Release.

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