Transmittals and MLN Matters articles: CMS covers STI screenings, creates new claims edits, updates PIM, and more
Medicare Weekly Update, January 31, 2012
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CMS covers sexually transmitted infection screenings
On January 26, CMS issued a pair of transmittals that state it will cover screening for Chlamydia, gonorrhea, syphilis, and hepatitis B with the appropriate FDA-approved lab tests used consistent with FDA-approved labeling and in compliance with Clinical Laboratory Improvement Amendments (CLIA) regulations. The screenings must be ordered by a primary care provider and performed by an eligible Medicare provider for these services.
CMS revises the Medicare Summary Notice for hospice services
On January 26, CMS revised the Medicare Summary Notice for hospice services to accurately reflect the description of services reported and correct the total charges reported for the claim.
CMS creates new edits to correct improper payments identified by recovery auditors
On January 26, CMS issued a transmittal that states it created edits to correct improper payments that have been identified by the recovery auditors. Edits installed for these issues include: claims related to pulmonary diagnostic procedures, IV hydration procedures, not a new patient, and global day surgery procedures.
On January 26, CMS issued a transmittal to make its regular update to the average sales price (ASP) drug pricing files under Part B.
CMS updates the list of codes exempt from POA reporting
On January 25, CMS issued a transmittal that lists ICD-9-CM codes that have either been added to or deleted from the list of diagnosis codes exempt from reporting a present on admission (POA) indicator effective October 1, 2011.
CMS updates instructions for IRF hospitals submitting no-pay bills
On January 25, CMS issued a transmittal that provides inpatient rehabilitation facility (IRF) hospitals updated instructions on submission of "no-pay" bills to Medicare for Medicare Advantage (MA) patients.
CMS implements edits to the CWF for PROVENGE®
On January 25, CMS issued a transmittal that provides edits for the common working file (CWF) to reject and contractors to deny claims for Autologous Cellular Immunotherapy Treatment of Metastatic Prostate Cancer (PROVENGE®) therapy where more than three claims had been paid in a patient’s lifetime.
CMS corrects error made in instructions for teaching hospitals reporting FICA refund for medical residents
On January 24, CMS issued a transmittal that rescinds Transmittal 1014, dated January 6, 2012, and replaces it with Transmittal 1017. The change corrects an error in the effective and implementation dates. All other information remains the same.
CMS updates chapter 15 of the PIM
On January 20, CMS issued the first in a series of transmittals designed to update chapter 15 of the Program Integrity Manual (PIM). The vast majority of the revisions will either be editorial in nature, or incorporate existing policies directly into chapter 15.
CMS clarifies billing instructions related to LTR days
On January 20, CMS issued a transmittal that clarifies billing instructions in the Medicare Claims Processing Manual, Chapter 3, Inpatient Hospital Billing, Section 40, Billing Coverage and Utilization Rules for PPS and Non-PPS Hospitals when life time reserve (LTR) days exhaust during the nonoutlier portion of an Inpatient Prospective Payment System (IPPS) stay.
CMS revises Hospital/CAH Database Worksheet
On January 20, CMS updated Exhibit 286, Hospital/CAH Database Worksheet, and added instructions for completing the worksheet.
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