Corporate Compliance

Transmittals and MLN Matters articles: CMS issues Medicare system update to include rendering line level NPI for PCIP payments to CAHs and much more

Medicare Insider, November 6, 2012

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CMS issues Medicare system update to include rendering line level NPI for PCIP payments to CAHs

On November 1, CMS issued a transmittal that updates Medicare systems to identify line level NPI information for purposes of PCIP payments to CAHS reimbursed under the optional method.

Effective date: April 1, 2013

Implementation date: April 1, 2013

View transmittal R2579CP.

View MLN Matters article MM8030.

CMS issues transmittal on enforcing interim billing for partial hospitalization services

On November 1, CMS issued a transmittal which states that in the CY 2013 Physician Fee Schedule final rule, CMS created a new G-code that will be used to report physician or qualifying nonphysician practitioner care management services for a patient following a discharge from partial hospitalization.

Effective date: January 1, 2013

Implementation date: April 1, 2013

View transmittal R2578CP.

CMS issues NCCI associated modifier changes/additions

On November 1, CMS issued a transmittal which states that additional modifiers shall be added to the list of NCCI-associated modifiers that will allow an edit with modifier indicator of “1” to be bypassed when the modifier is utilized correctly.

Effective date: January 1, 2013

Implementation date: January 7, 2013

View transmittal R1136OTN.

CMS issues transmittal on new field to Recovery Auditor daily and weekly reports

On November 1, CMS issued a transmittal that modifies/enhances the Recovery Auditor Data Warehouse Transaction Reports to reflect a new “Bankruptcy” field.

Effective date: April 1, 2013

Implementation date: April 1, 2013 (April 2013 release)

View transmittal R1138OTN.

CMS issues Affordable Care Act Section 3025 expansion of a field in the inpatient provider specific file

On November 1, CMS issued a transmittal in which it announces that it is expanding the numeric field in the inpatient PSF for the Readmissions Adjustment Factor.

Effective date/implementation date: April 1, 2013

View transmittal R2576CP.

CMS replaces transmittal on revisions to method of cost settlement for inpatient services for rural hospitals

On October 26, CMS replaced transmittal R84DEMO, containing information on the revisions to the method of cost settlement for inpatient services for rural hospitals participating under demonstration authorized by Section 410A of the Medicare Modernization Act.

View transmittal R85DEMO.

CMS issues January 2013 quarterly average sales price transmittal

On October 26, CMS issued a transmittal that provides the January 2013 quarterly average sales prices Medicare Part B drug pricing files and revisions to prior quarterly pricing files.

Effective date: January 1, 2013

Implementation date: January 7, 2013


View transmittal R2568CP.

CMS issues transmittal on implementation of the redesigned MSN

On October 26, CMS issued a transmittal which says that CMS is currently in the process of redesigning the Medicare Summary Notice (MSN).

Effective date: April 1, 2013 (for the April release); July 1, 2013 (for the July release); October 1, 2013 (for the October release)

Implementation date: April 1, 2013 (for the April release); July 1, 2013 (for the July release); October 1, 2013 (for the October release)

View transmittal R1130OTN.

CMS issues annual type of service update

On October 26, CMS issued a transmittal that includes the crosswalk of 2013 HCPCS codes to national type of service (TOS) indicators.

Effective date: January 1, 2013

Implementation date: January 7, 2013

View transmittal R2570CP.

CMS issues updated billing requirements for outpatient therapy services

On October 26, CMS issued a transmittal that publishes updated sections of Pub.100-04, Chapter 1 and Chapter 26. These chapters have been updated to reflect changes in Outpatient Therapy Services based on the Middle Class Tax Relief and Jobs Creation Act (MCTRJCA) of 2012.

Effective/implementation date: November 27, 2012

View transmittal R2571CP.

CMS replaces transmittal on payment of global surgical split care in a Method II CAH with modifiers -54 and/or -55

On October 26, CMS replaced transmittal R2510CP, containing instructions on implementing the payment methodology for global surgical split care submitted with a modifier 54 and/or 55 for CAH Method II providers.

View transmittal R2574CP.

CMS issues editing update for annual wellness visit

On October 26, CMS issued a transmittal that provides instructions for edits to be modified to only allow payment for either the practitioner or the facility for furnishing the AWV.

Effective/implementation date: April 1, 2013

View transmittal R2575CP.

View MLN Matters article MM8107.

CMS issues manual update to clarify SNF claims processing          

On October 26, CMS issued a number of transmittals that update the Medicare manuals to clarify key components of SNF claims processing.

Effective/implementation date: April 1, 2013

View the Medicare General Information, Eligibility, and Entitlement Manual transmittal.

View the Medicare Claims Processing Manual transmittal.

View the Medicare Benefit Policy Manual transmittal.

View MLN Matters article MM8044.



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