Corporate Compliance

This week in Medicare updates

Medicare Insider, August 26, 2014

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October 2014 update of the ambulatory surgical center (ASC) payment system
 
On August 15, CMS released a notification describing changes to and billing instructions for various payment policies implemented in the October 2014 ASC payment system update. This Recurring Update Notification applies to Chapter 14, section 10. As appropriate, this notification also includes updates to the Healthcare Common Procedure Coding System (HCPCS).
 
Effective date: October 1, 2014
Implementation date: October 6, 2014
 
View Transmittal R3025CP.
 
View MLN Matters article MM8880.
 
Specific modifiers for distinct procedural services
 
On August 15, CMS released a transmittal stating it is establishing four new HCPCS modifiers to define subsets of the -59 modifier, a modifier used to define a "Distinct Procedural Service."
 
Effective date: January 1, 2015
Implementation date: January 5, 2015
 
View Transmittal R1422OTN.
 
View MLN Matters article MM8863.
 
Revised modification to the medically unlikely edit (MUE) program
 
On August 15, CMS released a transmittal stating there are additional modifications to the MUE Program. The updates include clarifications and general processing instructions of the MUE Adjudication Indicator (MAI) 2 and MAI 3, with detailed explanations of the MAI 2 and MAI 3 for ASC and Method 2 CAHs.
 
Effective date: January 1, 2015
Implementation date: January 5, 2015
 
View Transmittal R1421OTN.

View MLN Matters article MM8853.
 
DMEPOS competitive bidding program: Correction to VMS processing of wheelchair accessory claims for Round 2
 
On August 15, CMS released a change request implementing corrections within VMS to address payments for wheelchair accessories furnished for use with Complex Group 2 and Group 3 Power Wheelchairs by contract suppliers for beneficiaries residing in a competitive bidding area (CBA); payments for competitively bid wheelchair accessories furnished for use with wheelchair base units that were not bid in Round 1 or Round 2 by contract and non-contract suppliers for beneficiaries residing in a CBA; payments for competitively bid wheelchair accessories that were not bid in Round 1 and that were furnished for use with any wheelchair base unit to beneficiaries residing outside a CBA; and payments for competitively bid wheelchair accessories that were not bid in Round 1 and that were furnished for use with wheelchair base units that were not competitively bid in Round 2 to beneficiaries residing in a CBA.
 
Effective date: January 1, 2015
Implementation date: January 5, 2015 for claims processed on or after this date
 
View Transmittal R1420OTN.
 
View MLN Matters article MM8864.
 
Open Payments system reopens, extends physician registration and review period
 
On August 15, CMS announced that the Open Payments system is once again available for physicians and teaching hospitals to register, review and, as needed, dispute financial payment information received from health care manufacturers. The system was taken offline on August 3 to resolve a technical issue. To account for the system’s down time, CMS is extending the time for physicians and teaching hospitals to review their records to September 8, 2014. The public website will be available on September 30, 2014.
 
View the press release.
 
Nursing facilities' compliance when reporting allegations of abuse or neglect
 
On August 18, OIG posted a report detailing the results of a study regarding nursing facilities developing and implementing written policies related to reporting allegations of abuse and neglect in order to comply with federal regulations.
 
View the report.
 
Hospital IPPS for acute care and long-term care hospital prospective payment system (LTCH PPS) and FY 2015 rates; quality reporting for specific providers; reasonable compensation equivalents for physician services in certain hospitals; Appeals and Judicial Review; organ transplant center enforcement provisions; and EHR Incentive Program
 
On August 22, CMS announced in the Federal Register it is revising the Medicare hospital IPPS for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems. Some of these changes implement certain statutory provisions contained in the Affordable Care Act of 2010, the Protecting Access to Medicare Act of 2014, and other legislation. It is also updating the payment policies and the annual payment rates for the Medicare PPS for inpatient hospital services provided by LTCHs and implementing certain statutory changes to the LTCH PPS. It is also making changes relating to direct graduate medical education and indirect medical education payments, establishing new requirements or revising requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, and LTCHs) participating in Medicare and updating policies relating to the Hospital Value-Based Purchasing Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition Reduction Program.
 
View the notice in the Federal Register.
 
FY 2015 hospice wage index and payment rate update, quality reporting requirements and process and appeals for Part D payment for drugs for beneficiaries enrolled in hospice
 
On August 22, CMS posted a notice of a final rule in the Federal Register updating the hospice payment rates and the wage index for FY 2015 and continuing the phase-out of the wage index budget neutrality adjustment factor (BNAF). This rule provides an update on hospice payment reform analyses, potential definitions of “terminal illness” and “related conditions,” and information on potential processes and appeals for Part D payment for drugs while beneficiaries are under a hospice election. It also specifies timeframes for filing the notice of election and the notice of termination/revocation, add the attending physician to the hospice election form, and require hospices to document changes to the attending physician; require hospices to complete their hospice aggregate cap determinations within 5 months after the cap year ends, and remit any overpayments; and update the hospice quality reporting program. In addition, it will provide guidance on determining hospice eligibility; information on the delay in the implementation of ICD– 10–CM; and will further clarify how hospices are to report diagnoses on hospice claims.
 
View the notice in the Federal Register.
 
Meeting of the Advisory Panel on Outreach and Education (APOE)
 
On August 20, CMS posted a notice in the Federal Register announcing a meeting of APOE in accordance with the Federal Advisory Committee Act. The meeting will be held Friday, September 12 at 8:30 a.m. Deadline for registration, presentations, and comments is Friday, August 29.
 
View the notice in the Federal Register.



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