Corporate Compliance

The week in Medicare updates

Medicare Insider, March 25, 2014

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Implement operating rules - Phase III ERA EFT: CORE 360 Uniform Use of Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC) Rule - Update from CAQH CORE - October 1, 2013 version 3.0.3
 
On March 18, CMS issued a rescind and replace transmittal to include two attachments for v3.0.3 and v 3.0.4 of the Council for Affordable Quality Health Care Committee on Operating Rules for Information Exchange Mandated CARC/RARC Code Combination List.
 
View Transmittal R1360OTN.
 
View MLN Matters article MM8518.
 
The Coordination of Benefits Contractor to remove and no longer apply federal tax information received through the Internal Revenue Service, Social Security Administration, CMS Medicare Secondary Payer Data Match program on the Common Working File
On March 18, CMS issued a rescind and replace transmittal \to update BR 8353.3.1 and allow the Medicare Contractors to complete internal file updates within 45 calendar days after the installation of the July 2014 Quarterly Release.
 
 
Medicare program: extension of the payment adjustment for low-volume hospitals and the Medicare-dependent hospital program
On March 18, CMS and HHS issued an interim final rule to change the payment adjustment for low-volume hospitals and the Medicare-dependent hospital program under the hospital IPPS for FY 2014 (through March 21, 2014) in accordance with sections 1105 and 1106, respectively, of the Pathway for SGR Reform Act of 2013.
 
 
 
Correction notice to IPPS Final Rule
On March 18, CMS and HHS issued a document to correct technical errors in the FY 2014 IPPS/LTCH PPS final rule, which appeared in the Federal Register August 19, 2013.
 
 
Correction notice to 2013 IPPS Final Rule
On March 18, CMS and HHS issues a federal register notice to correct technical errors in the FY 2013 IPPS/LTCH PPS final rule, which appeared in the Federal Register August 31, 2012.
 
 
Comparing average sales prices and average manufacturer prices for Medicare Part B drugs: an overview of 2012
On March 14, OIG issued a report of its findings from a study of drug codes. The OIG found that under CMS' price substitution policy, 14 drug codes would have been
subject to reimbursement reductions on the basis of data from 2012, saving Medicare and its beneficiaries an estimated $1.8 million between the fourth quarter of 2012 and the third quarter of 2013. However, because CMS did not begin substituting prices until the second quarter of 2013, only eight drug codes were actually subject to reductions, generating an estimated $819,000 in savings.
 
 
Results of reviews at three suppliers of diabetic testing supplies
On March 4, OIG issued the results of a review of three suppliers of diabetic testing supplies.
 
 
Compendium of priority recommendations
On March 18, the OIG posted the “Compendium of Priority Recommendations: March 2014 Edition,” which presents opportunities to achieve cost savings, improve program management, and ensure quality of care and safety of beneficiaries.
 
 
Medicare Care Choices Model
On March 18, CMS issued a fact sheet about the Medicare Care Choices Model, which will test improvements to certain Medicare beneficiaries' quality of life while they are receiving both curative and palliative care.
 
 
Percutaneous image-guided lumbar decompression for lumbar spinal stenosis
On March 18, CMS posted the final decision memo for this NCA.
 
 
Lung cancer screening with low dose computed tomography
On March 21, CMS posted questions to the panel for this NCA/CAL.
 
 
Home Health Agency State Operations Manual revisions: Appendix B, HHA Enforcement Guidance and revisions to Chapter 2, Certification Process
On March 14, CMS updated State Operations Manual Appendix B – Guidance to Surveyors: Home Health Agencies. The recent establishment of survey and enforcement regulations as well as changes to other HHA policies have necessitated revisions to previously published survey guidance.
 
 
Hospital Conditions of Participation (CoP) on medication administration, including after surgery
On March 14, CMS updated its guidance on CoP requirements for the hospital medication administration, IV medications and blood transfusions, and the need for patient risk assessment and appropriate monitoring during and after medication administration, particularly for post-operative patients receiving IV opioid medications.  

View Survey and Certification letter.
 
Interpretive Guidance for the Survey Process of the Organ
Procurement Organization (OPO) Conditions for Coverage, published
May 31, 2006, in the Federal Register – Interim Final
On March 14, CMS released a memorandum that communicates an advanced copy of the Interpretive Guidance and associated revisions to Chapters 2 and 3 of the State Operations Manual for the OPO Conditions for Coverage.

View Survey and Certification letter.



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