Corporate Compliance

The week in Medicare updates

Medicare Insider, July 8, 2014

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CMS updates contractor instructions for enrollment and re-enrollment applications
 
On June 27, CMS posted a transmittal to update and reorganize Medicare Program Integrity, Chapter 15, Sections 15.7.1 through 15.7.2.2. It clarifies existing Form CMS-855, Medicare enrollment application, processing practices and does not add new requirements. New or revised tasks are outlined in the change request’s business requirements.
 
Effective date: July 29, 2014
Implementation date: July 29, 2014
 
View Transmittal R525PI.
 
Removal of national non-coverage of transsexual surgery
 
On June 27, CMS released a change request to implement the Departmental Appeals Board decision consistent with 42 CFR § 426.560(b)(2) by removing section 140.3, Transsexual Surgery, from the Medicare National Coverage Determinations Manual. Additionally, references to non-coverage of transsexual surgery have been removed from the Medicare Benefit Policy Manual. The transmittal clarifies that June 29, 2014, was referred to as the effective date in recent communication however it is actually the implementation date and the effective date is May 30, 2014.
 
View Transmittal R189BP.
 
View Transmittal R169NCD.

CMS posted CY 2015 Home Health Prospective Payment System (HHPPS) proposed rule

On July 1, CMS issued the CY 2015 HHPPS Proposed Rule, proposing changes to the Medicare home health prospective payment system (HH PPS). This includes updated to the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor under the Medicare prospective payment system for home health agencies (HHAs), effective January 1, 2015.
 
View the fact sheet.
 
View the proposed rule.
 
OIG posted compliance education on prescription drug advertising for providers

On July 2, OIG posted, on its Compliance 101 site, FDA education for providers on the role they can play in helping the agency ensure prescription drug advertising and promotion is truthful and not misleading. The FDA's Office of Prescription Drug Promotion in the Center for Drug Evaluation and Research developed the compliance program focusing on educating healthcare providers, including an e-learning course offering CMEs and case studies as well as the FDA’s BadAd Program Brochure.
 
View the Compliance 101 website.
 
CMS posted CY 2015 OPPS proposed rule

On July 3, CMS issued the CY 2015 OPPS Proposed Rule. The rule proposes changes to the OPPS along with several other policy changes. The proposed rule further refines the Comprehensive Ambulatory Payment Classifications and proposes conditional packaging of almost all ancillary services with a mean cost of $100 or less. The rule proposes to implement a modifier to monitor payments for off-campus provider based departments. In addition to outpatient proposals, the rule also proposes to eliminate the certification requirement for most inpatient stays.
 
View the fact sheet on policy and payment proposals.
 
View the fact sheet on quality proposals.
 
View the notice in the Federal Register. 
 
CMS posted CY 2015 Medicare Physician Fee Schedule Proposed Rule

On July 3, CMS issued the CY 2015 Medicare Physician Fee Schedule. Most notably, the rule proposes to eliminate the global period by CY 2017, changing all 10- and 90-day global periods to zero days.
 
View the fact sheet on policy and payment proposals.
 
View the fact sheet on quality proposals.
 
View the notice in the Federal Register.



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