Corporate Compliance

The week in Medicare updates

Medicare Insider, April 15, 2014

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Termination of the Common Working File ELGA, ELGH, HIQA, HIQH, and HUQA Part A Provider Queries
On April 8, CMS issued rescind and replace transmittal to remove reference to the queries terminated in April 2014. All other information remains the same.
 
Effective date: April 7, 2014
Implementation date: April 7, 2014
 
 
 
 
Implementation of NACHA Operating Rules for Healthcare Electronic Funds Transfers
On April 9, CMS issued a change request to implement compliance with NACHA operating
rules that took effect on September 20, 2013, specifically those that apply to originators of healthcare payments via the ACH payment network.
 
Effective date: July 1, 2014
Implementation date: July 7, 2014
 
 
 
Medicare Claims Processing Manual to Provide Language-Only Changes for Updating ICD-10 and ASC X12
On April 10, CMS issued a change request about language-only changes for updating ICD-10 and ASC X12 language in Pub 100-04, Medicare Claims Processing Manual, Chapter 11. There are no new coverage policies, payment policies, or codes introduced in this transmittal. Specific policy changes and related business requirements have been announced previously in various communications. Also, the title for section 110 was changed to delete the letter “N” after the X12. This is the only change to the title for section 110.
 
Effective date: October 1, 2014
Implementation date: October 1, 2014
 
 
 
Enforcement of the 5-day payment limit for respite care under the Hospice Medicare Benefit
 
On April 10, CMS issued a change request enforcing the current policy that limits payment of respite care to no more than 5 consecutive days.
 
Effective date: July 1, 2014
Implementation date: July 7, 2014
 
 
 

April 2014 update of the Ambulatory Surgical Center payment system
On April 10, CMS issued a Recurring Update Notification describing changes to and billing instructions for various payment policies implemented in the April 2014 ASC payment system update. This applies to chapter 14, section 10. As appropriate, this notification also includes updates to HCPCS.
 
Effective date: April 1, 2014
Implementation date: April 7, 2014
 
 
 
 
Clarification of remittance advice code combination reports generated by shared systems
On April 10, CMS issued a change request clarifying the instruction to generate a monthly report to identify code combinations that have been used by MACs outside of the current code combinations list per Operating Rules - Business Requirement 7 in CR 8182. CMS clarified that a quarterly report capturing all (both compliant as well as non-compliant) code combinations in the inventory must also be generated. This quarterly inventory report, essentially has a time period of one day (i.e., January 1, April 1, July 1, and October 1). Those are the days the shared systems should provide a full list of codes that exist in the system. The change request provides specific instructions about the fields that need to be in these reports and how to share the reports with CMS. Two templates have been attached to the change request that will be uploaded by the MACs to http://www.dtasdata.info by the seventh of the following month.
 
Effective date: July 1, 2014
Implementation date: July 7, 2014 - MCS and VMS (Analysis and Coding); October 6, 2014 - FISS and VMS (Coding, Testing, and Implementation).

View Transmittal R1369OTN.
 
 
Privacy Act of 1974, reports of new system of records
On April 8, CMS and HHS issued a notice that CMS is establishing a new system of records titled "Hospice Item Set (HIS) System," System No. 09-07-0548. The new system will support the collection of data required for the Hospice Quality Reporting Program.
 
 
 
Questionable billing for Medicare electrodiagnostic tests
On April 7, the OIG issued a report in which it analyzed Medicare 2011 electrodiagnostic test claims to identify physicians who had unusually high billing for at least one of seven measures of questionable billing.
 
 
 
CMS generally met requirements in the Durable Medical Equipment competitive bidding round 1 rebid program
On April 8, the OIG issued a report determining that CMS generally selected durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers and correctly computed the sampled DMEPOS single payment amounts in accordance with its established procedures and applicable Federal requirements.
 
 
 
Strengthening Medicare Advantage
On April 7, CMS issued a fact sheet stating that the policies in the 2015 Medicare Advantage and Part D Rate Announcement and final Call Letter continue the successful implementation of the Affordable Care Act’s reforms that improve quality and provide greater protections for beneficiaries and value for taxpayers.
 
 
 
HHS releases physician-level Medicare data
On April 9, HHS released a new privacy-protected data set that has information on the number and type of health care services that individual physicians and certain other health care providers furnished in 2012 under the Medicare Part B fee-for-service (FFS) program, as well as information on the amount that Medicare paid them for those services.
 
 
 
 
CMS ensures higher value and quality for Medicare health and drug plans
On April 7, CMS issued the 2015 rate announcement and final call letter for Medicare Advantage and prescription drug benefit (Part D) programs.
 

 

 



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