Corporate Compliance

Transmittals and MLN Matters articles: CMS issues transmittal on testing HIPAA transactions following a system change, updates chapter 41 of the Provider Reimbursement Manual, and more

Medicare Insider, November 20, 2012

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CMS issues transmittal on testing HIPAA transactions following a system change

On November 16, CMS issued a transmittal that instructs Shared System Maintainers and contractors to test/identify and develop resolution for any resulting Out of Balance (OOB) situation for ASC X12 Transaction 835 after implementing system change.

Effective date: April 1, 2013

Implementation date: April 1, 2013

View transmittal R2594CP.

CMS updates chapter 41, Provider Reimbursement Manual

On November 16, CMS issued a transmittal that updates Chapter 41, Skilled Nursing Facility and Skilled Nursing Facility Complex Cost Reports, Form CMS-2540-10. This transmittal clarifies and corrects existing instructions applicable to cost reporting periods ending on or after November 30, 2011.

Effective date: Cost reporting periods ending on or after July 31, 2012

View transmittal R4pr241.

CMS issues transmittal on new screens and processes for coding conversions

On November 16, CMS issued a transmittal that develops new conversion screens for ICD-9/ICD-10, ICD-10/ICD-9 diagnosis codes and procedure codes using GEMS 2013 tables in HIMR Inquiry system.

Effective date: April 1, 2013; July 1, 2013

Implementation date: April 1, 2013 (CWF: Update to HIMR screens for ICD 10 diagnosis and procedure code provisions for Business Requirements 8034.1, 8034.1.1, 8034.1.2, 8034.1.3, 8034.1.4, 8034.1.5, 8034.1.6, 8034.1.8, 8034.1.8.1, 8034.1.9, 8034.9, 8034.9.1, 8034.10, 8034.11 and 8034.12);

July 1, 2013 (CWF: Update for Exact Diagnosis Matching and Family of Diagnosis Codes; VSAM File and new SP and MSP edits. BRs 8034.1.7, 8034.2, 8034.3, 8034.3.1, 8034.3.2, 8034.4, 8034.4.1, 8034.5, 8034.6, 8034.6.1, 8034.6.3, 8034.7, 8034.8, 8034.13, 8034.14)

View transmittal R1152OTN.

CMS issues home health prospective payment system rate update for CY2013

On November 16, CMS issued a transmittal that updates the 60-day national episode rates, the national per-visit amounts, LUPA add-on amount, the non-routine medical supply payment amounts, the fixed dollar loss ratio, and the labor and non-labor percentages under the HH PPS for CY 2013.
Effective date: January 1, 2013

Implementation date: January 7, 2013

View transmittal R2592CP.

CMS issues instructions for downloading the Medicare ZIP code file for April 2013

On November 16, CMS issued a transmittal that describes the process for updating the two Medicare ZIP Code files (ZIP5 and ZIP9) for the April 2013 quarter.

Effective date: April 1, 2013

Implementation date: April 1, 2013

View transmittal R2591CP.

CMS issues transmittal on use of Q6 modifier for locum tenens by providing performing provider NPI

On November 16, CMS issued a transmittal which instructs on the use of HCPCS Q6 modifier as it pertains to the use of substitute services.

Effective date: April 1, 2013

Implementation date: April 1, 2013

View transmittal R1151OTN.

CMS issues transmittal on bariatric surgery for treatment of morbid obesity NCD

On November 9, CMS issued a transmittal which states that effective for claims with dates of service on or after June 27, 2012, MACs acting within their respective jurisdictions may determine coverage of stand-alone laparoscopic sleeve gastrectomy (LSG) for the treatment of co-morbid conditions related to obesity in Medicare beneficiaries only when all of the following conditions a-c are satisfied.

a. The beneficiary has a body-mass index (BMI) ≥ 35 kg/m2,

b. The beneficiary has at least one co-morbidity related to obesity, and,

c. The beneficiary has been previously unsuccessful with medical treatment for obesity.

Effective date: June 27, 2012

Implementation date: December 10, 2012

View transmittal R148NCD.

View MLN Matters article MM8028.



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