Corporate Compliance

The week in Medicare updates

Medicare Insider, August 5, 2014

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Update to Medicare Claims Processing Manual, Chapters 12, 20, 32, and 35 to provide language-only changes for updating ICD-10 and ASC X12
 
On July 25, CMS released several change requests containing language-only changes for updating ICD-10 and ASC X12 language in Pub 100-04, Medicare Claims Processing Manual.  Additionally, references to CMS contractor types have been replaced with Medicare Administrative Contractors (MACs) in the sections that are updated by this transmittal. There are no new coverage policies, payment policies, or codes introduced in this transmittal.
 
Effective date: Upon implementation of ICD-10; January 1, 2012 - ASC X12
Implementation date: August 25, 2014 - ASC X12; Upon Implementation of ICD-10
 
View Transmittal R2998CP.
 
View Transmittal R2997CP.
 
View Transmittal R2994CP.
 
View Transmittal R2993CP.
 
Remittance advice remark and claims adjustment reason code and Medicare remit easy print
 
On July 25, CMS released a change request to updates the Claim Adjustment Reason Code and Remittance Advice Remark Code lists and also instructs VIPs and FISS to update Medicare Remit Easy Print and PC Print. This Recurring Update Notification applies to Chapter 22, sections 40.5, 60.1, and 60.2.
 
Effective date: October 1, 2014
Implementation date: October 6, 2014
 
View Transmittal R996CP.
 
View MLN Matters article MM8855.
 
Consolidation of HIGLAS organizations for a MAC-organization merges
 
On July 25, CMS released a change request defining the consolidation of multiple HIGLAS organizations accomplished with the move to one organization in HIGLAS. The organization numbers for these MACs will not be changing with this consolidation and are defined in this change request.
 
Effective date: July 27, 2014
Implementation date: July 27, 2014
 
View Transmittal R1397OTN.
 
Provider education regarding new demonstration codes for SNF claims and payment of SNF claims for Bundled Payments for Care Improvement Model 2 beneficiaries
 
On July 25, CMS released a change request to direct Medicare Administrative Contractors to engage in provider education regarding use of a demonstration code when utilizing a waiver of the 3-day hospital stay requirement for SNF claims for participants who qualify for use of the waiver under Model 2 of the Bundled Payments for Care Improvement initiative (BPCI).
 
Effective date: October 27, 2014
Implementation date: October 27, 2014
 
View Transmittal R106DEMO.
 
View MLN Matters article MM8792.
 
View the fact sheet.
 
Evaluation criteria and standards for Beneficiary and Family Centered Care (BFCC) Quality Improvement Organizations (QIO) contract
 
On July 28, CMS posted a notice in the Federal Register regarding their intention to evaluate effectiveness and efficiency of BFCC QIOs that will enter into contracts with CMS. This contract allows for a transition period from the incumbent QIOs to the successor QIOs.  Comments are due by August 27.
 
View the notice in the Federal Register.
 
Hospital IPPS for Acute Care Hospitals and the LTCH PPS and Fiscal Year 2014 Rates; Quality Reporting Requirements for Specific Providers; Hospital Conditions of Participation; Payment Policies Related to Patient Status; Correcting Amendment
 
On July 30, CMS posted a document to correct technical errors in the final rule that appeared in the August 19, 2013.
 
View the notice in the Federal Register.
 
OIG Hearing: “Admitted or Not? The Impact of Medicare Observation Status on Seniors”
 
On July 31, OIG posted a hearing record regarding the hearing entitled “Admitted or Not? The Impact of Medicare Observation Status on Seniors”.
 
View the hearing record.
 
FY 2015 payment and policy Changes for IRF
 
On July 31, CMS issued a final rule updating FY 2015 Medicare payment policies and rates for the IRF Prospective Payment System and the IRF Quality Reporting Program.
 
View the final rule.
 
View the fact sheet.
 
Trustees Report shows continued reduced cost growth, longer Medicare solvency
 
On July 28, the Medicare Trustees projected that the trust fund that finances Medicare’s hospital insurance coverage will remain solvent until 2030, four years beyond what was projected in last year’s report. Due in part to cost controls implemented in the Affordable Care Act, per capita spending is projected to continue to grow slower than the overall economy for the next several years.
 
View the press release.
 
CMS extends moratoria for newly enrolling ground ambulance suppliers & home health agencies
 
On July 29, CMS announced it will extend its current enrollment moratoria on new ground ambulances in the Houston and Philadelphia metropolitan areas and new home health agencies in the metropolitan areas of Chicago, Fort Lauderdale, Detroit, Dallas, Houston, and Miami. See press release for full list.  
 
View the notice in the Federal Register.
 
View the press release.
 
Deadline for ICD-10 allows health care industry ample time to prepare for change
 
On July 31, HHS issued a rule today finalizing October 1, 2015 as the new compliance date for healthcare providers, health plans, and health care clearinghouses to transition to ICD-10, the tenth revision of the International Classification of Diseases. This deadline allows providers, insurance companies and others in the healthcare industry time to ramp up their operations to ensure their systems and business processes are ready to go on October 1, 2015.
 
View the press release.
 
CMS collecting information on Independent Rural Health Clinic/Freestanding Federally Qualified Health Center Cost Report form
 
On August 1, CMS posted a notice that it is accepting comments regarding CMS–222–92, Independent Rural Health Clinic/Freestanding Federally Qualified Health Center Cost Report. Comments are due by September 2.
 
View the notice in the Federal Register.



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