Corporate Compliance

The week in Medicare updates

Medicare Insider, May 13, 2014

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On May 2, CMS released a change request to update various sections of Chapter 15 of the Program Integrity Manual. The changes largely, though not exclusively, address the ?recommendation for approval? letters that Medicare Administrative Contractors send to the state agencies and CMS Regional Offices.
 
Effective date: June 4, 2014
Implementation date: June 4, 2014
 
View Transmittal R514Pl.
 
2014 annual update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment
 
On May 2, CMS released a Recurring Update Notification to provide instructions for Chapter 16, Section 20 of the revised 2014 Clinical Laboratory Fee Schedule.
 
Effective date: January 1, 2014 (unless otherwise specified, the effective date is the date of service)
Implementation date: On or before June 30, 2014
 
View Transmittal R2948CP.
 
View MLN Matters Article MM8695.
 
Medicare system updates
 
On May 2, CMS released a one-time notification to provide instructions for changes in the DMEPOS Fee Schedule File and Alpha-Numeric HCPCS file for splints, casts, and certain intraocular lenses. This is a companion to Change Request (CR) 8645, Transmittal 2902, April Quarterly Update for 2014 DMEPOS Fee Schedule.
 
Effective date: October 1, 2014
Implementation date: October 6, 2014
 
View Transmittal R2947CP.
 
Revision of Medicare Contractor Beneficiary and Provider Communications Manual
 
On May 2, CMS released a change request to revise Pub. 100-09, Chapter 6 of the Medicare Contractor Beneficiary and Provider Communications Manual, which includes the URL for the MAC Internet-based Provider Portal Handbook so that the handbook can be cleared as part of the revision of Chapter 6. CMS will also delete Pub. 100-09, Chapter 3, Provider Inquiries, which became obsolete in 2009 when its contents were merged into Chapter 6.
 
Effective date: July 2, 2014
Implementation date: July 2, 2014
 
View Transmittal R28COM.
 
Present on Admission (POA) Indicator editing for Maryland waiver hospitals
 
On May 2, CMS released a transmittal stating hospitals in Maryland operating under waivers will be required to report valid POA indicators for principal and secondary diagnoses and will continue to be exempt from the application of the hospital-acquired condition provision.
 
Effective date: October 1, 2014
Implementation date: October 6, 2014
 
View Transmittal R1380OTN.
 
View MLN Matters Article MM8709.
 
CRNA-related services in a Method II Critical Access Hospital (CAH)
 
On May 2, CMS released an instruction to clarify the payment for reasonable and necessary medical or surgical services performed by an anesthesiologist or CRNA in a method II CAH.
Effective date: January 1, 2014
Implementation date: October 6, 2014
View Transmittal R1379OTN.
 
View MLN Matters Article MM8708.

Phase III ERA EFT: CORE 360 Uniform Use of Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC) Rule
 
On May 2, CMS released a change request to instruct the contractors and Shared System Maintainers to update the CORE 360 Uniform Use of CARC and RARC Rule per attachment. The attachment shows the CORE Code Combination Updates based on Code Updates published on June 1, 2014.
Effective date: September 2, 2014, for A/B MACs; October 1, 2014, for FISS, VMS, and DME MACs
Implementation date: September 2, 2014, for A/B MACs; October 6, 2014, for FISS, VMS, and DME MACs
View Transmittal R1378OTN.
 
View MLN article MM8711.
 
Prospective payment system and consolidated billing for skilled nursing facilities (SNF) for FY 2015
On May 6, CMS issued a proposed rule to update the payment rates used under the prospective payment system for SNF for FY 2015, adopt the most recent Office of Management and Budget statistical area delineations to identify a facility’s urban or rural status, and revisions to policies related to the Change of Therapy Other Medicare Required Assessment.
 
View the notice on the Federal Register.
 
View the comment docket.  Comments are due by June 30.
 
FY 2015 Hospice updates
 
On May 7, CMS released a proposed rule that would update the hospice payment rates and wage index for fiscal year FY2015 and continue the phase out of the wage index budget neutrality adjustment factor. In addition, this rule would provide guidance on determining hospice eligibility, information on the delay in the implementation of ICD-10-CM, and would further clarify how hospices are to report diagnoses on hospice claims. Finally, the rule proposes to make a technical regulatory text change.
 
View the notice on the Federal Register.

View the fact sheet.
 
 
View the comment docket. Comments are due by July 1.
 
Announcement of application from a hospital requesting waiver for organ procurement service area
 
On May 8, CMS released a notice with comment period stating that a hospital has requested a waiver of statutory requirements that would otherwise require the hospital to enter into an agreement with its designated Organ Procurement Organization (OPO). This notice requests comments from OPOs and the general public for our consideration in determining whether CMS should grant the requested waiver.
Comments are due by July 7.
 
View the notice in the Federal Register.
 
Revisions to the OIG’s exclusion authorities
 
On May 9, the OIG released a proposed rule amending the regulations related to exclusion authorities under the authority of the OIG of HHS. The proposed rule would incorporate statutory changes, propose early reinstatement procedures, and clarify existing regulatory provisions. 
View the document.
 
 
View the comment docket.  Comments due by July 8.
 
 
Reforms of regulatory requirements to save healthcare providers $660 million annually
 
On May 7, CMS issued a press release stating reforms to Medicare regulations identified as unnecessary, obsolete, or excessively burdensome on hospitals and other healthcare providers will save nearly $660 million annually, and $3.2 billion over five years through the 2015 IPPS Proposed Rule.
 
View the press release.
 
CMS restructures Quality Improvement Organization (QIO) Program
 
On May 9, CMS released a statement that it is taking the first step in restructuring the QIO Program to improve patient care, health outcomes, and save taxpayer resources. The first phase of the restructuring will allow two Beneficiary and Family-Centered Care QIO contractors to support the program’s case review and monitoring activities separate from the traditional quality improvement activities of the QIOs.
 
View the press release.
 
Proposed updates to the Medicare hospital IPPS
 
CMS is proposing to revise the Medicare hospital IPPS for operating and capital-related costs of acute
care hospitals to implement changes arising from its continuing experience with these systems. Some of the proposed changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 and the Protecting Access to Medicare Act of 2014, and other legislation. These proposed changes would be applicable to discharges occurring on or after October 1, 2014, unless otherwise specified in the proposed rule.
 
View the proposed rule.
 
Publication of Final Rule CLIA “TEST ACT” for Proficiency Testing (PT) Referral
 
On May 2, CMS released a final rule that implements the TEST Act and provides the prescriptive framework for the application of sanctions in PT referral cases. The rule allows for a better fit between the nature and extent of an intentional PT referral violation and the penalties that are imposed. It includes the three tiered categories of sanctions for a PT referral (including revocation of the CLIA Certificate and/or alternative sanctions) to be applied under certain specified conditions, based on the severity and extent of the violation.
 
View the document.
 
View the survey and certification letter



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