Corporate Compliance

Important Medicare updates

Medicare Insider, March 19, 2013

Want to receive articles like this one in your inbox? Subscribe to Medicare Insider!

CMS issues guidance on Part B inpatient billing in hospitals

On March 18, CMS issued in the Federal Register a notice of ruling that establishes a policy that revises the current policy on Part B billing following the denial of a Part A inpatient hospital claim by a Medicare review contractor on the basis that the inpatient admission was determined not reasonable and necessary. CMS also issued a proposed rule that would revise Part B billing policies when a Part A claim for a hospital inpatient admission is denied as not medically reasonable or necessary.

View the ruling.

View the proposed rule.

View a related fact sheet.

CMS issues quarterly update of HCPCS codes used for home health consolidated billing enforcement

On March 15, CMS issued a transmittal containing a quarterly update to the list of HCPCS codes used by Medicare systems to enforce a consolidated billing of home health services.

Effective date: July 1, 2013

Implementation date: July 1, 2013

View transmittal R2672CP.

CMS issues new waived tests

On March 15, CMS issued a transmittal that will inform contractors of new CLIA waived tests approved by the FDA.

Effective date: July 1, 2013

Implementation date: July 1, 2013

View transmittal R2671CP.

CMS issues implementation of the award for the J6 A/B MAC

On March 15, CMS issued a transmittal that announces the implementation of the jurisdiction 6 Part A, RHHI Region D, and Part B Medicare administrative contractor (J6 A/B MAC). New workload numbers shall be assigned for the Part B processing states of Illinois, Minnesota, Wisconsin and Part A processing state of Minnesota.

Effective date: July 1, 2013

Implementation date: July 1, 2013

View transmittal R1197OTN.

CMS issues transmittal on ICD-10 conversion from ICD-9

On March 15, CMS issued a transmittal that creates and updates NCD hard-coded shared system edits that contain ICD-9 diagnosis codes with comparable ICD-10 diagnosis codes plus all associated coding infrastructure such as procedure codes, HCPCS/CPT codes, denial messages, frequency edits, POS/TOB/provider specialties, etc.

Effective date: July 1, 2013 (BR5, NCD110.4, ICD-9 996.88 and BR6, NCD190.11); October 1, 2014

Implementation date:: July 1, 2013 (Analysis/Design for FISS and MCS -(Exception: BR5,

NCD110.4, ICD-9 996.88 and BR6, NCD190.11, various ICD-9 codes, effective July 1, 2013); October 7, 2013 (Implementation for FISS, MCS, and CWF. All CWF work will occur in the October 2013 Release.

View transmittal R1199OTN.

CMS issues transmittal on Medicare travel allowance fees for collection of specimens

On March 15, CMS issued a transmittal that revises the payment of travel allowances when billed on a per mileage basis using HCPCS code P9603 and when billed on a flat rate basis using HCPCS code P9604 for CY 2013.

Effective date: January 1, 2013

Implementation date: June 17, 2013

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R2675CP.pdf

CMS issues memo for hospitals, CAHs, and ASCs

On March 15, CMS issued a memo that contained guidance for hospitals, critical access hospitals (CAH), and ambulatory surgical centers (ASC) related to various rules reducing provider/supplier burden.

View the memo.

CMS issues memo on AHRQ common formats

On March 15, CMS issued a memo containing information for hospitals and state survey agencies related to comprehensive safety reporting using AHRQ common formats.

View the memo.

CMS issues revisions to Appendix E and chapter 2 of the State Operations Manual

On March 15, CMS issued a transmittal that updates numerous sections of the appendix and sections 2290 and 2308 of the State Operations Manual.

Effective date: March 15, 2013

Implementation date: March 15, 2013

View transmittal R83SOM.

CMS issues July 2013 quarterly average sales price Part B drug pricing files and revisions

On March 15, CMS issued a transmittal that contains the July 2013 quarterly average sales price Part B drug pricing files and revisions to prior quarterly pricing files.

Effective date: July 1, 2013

Implementation date: July 1, 2013

View transmittal R2676CP.

CMS replaces transmittal on changes to chapter 1 of the Program Integrity Manual

On March 14, CMS replaced transmittal R451PI, containing the addition of section 1893(b)(1) to the list of statutory authorities, and updates the OIG links for provider self-audits in the Program Integrity Manual.

Effective date: April 1, 2013

Implementation date: April 1, 2013

View transmittal R454PI.

CMS issues NCA for positron emission tomography for solid tumors

On March 14, CMS issued a national coverage analysis for positron emission tomography (FDG) for solid tumors (CAG-00191R4).

View the NCA.

CMS issues corrections to 2013 IPPS final rule

On March 13, CMS issued in the Federal Register a document that corrects technical errors to the 2013 IPPS final rule in the correcting document that appeared in the October 2, 2012 Federal Register.

View the corrections.

CMS replaces transmittal on quarterly update to CCI edits

On March 11, CMS replaced transmittal R2609CP, containing the update to the CCI procedure to procedure edits.

Effective date: April 1, 2013

Implementation date: April 1, 2013

View transmittal R2669CP.



Want to receive articles like this one in your inbox? Subscribe to Medicare Insider!

Most Popular