Corporate Compliance

This week in Medicare updates

Medicare Insider, October 14, 2014

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2015 annual update of HCPCS codes for SNF consolidated billing (CB) update
 
On October 3, CMS released a change request stating changes to HCPCS codes and Medicare Physician Fee Schedule designations will be used to revise CWF edits to allow A/B MACs to make appropriate payments in accordance with policy for SNF CB in Chapter 6, Medicare Claims Processing Manual, Section 110.4.1 for A/B MACs (B) and Chapter 6, Section 20.6 for A/B MACs (A).
 
Effective date: January 1, 2015
Implementation date: January 5, 2015
 
View Transmittal R3088CP.
 
View MLN Matters article MM8943.
 
2015 annual update for the Health Professional Shortage Area (HPSA) bonus payments
 
On October 3, CMS released a change request providing files for the automated payments of HPSA bonuses for dates of service January 1, 2015 through December 31, 2015. This Recurring Update Notification applies to Chapter 4, Section 250.2 and Chapter 12, Section 90.4.2 of the Medicare Claims Processing Manual.
 
Effective date: January 1, 2015
Implementation date: January 5, 2015
 
View Transmittal R3087CP.
 
View MLN Matters article MM8942.
 
Intensive Cardiac Rehabilitation (ICR) Program-Benson-Henry Institute Cardiac Wellness Program
 
On October 3, CMS released a change request in which Medicare determined there is sufficient evidence to expand the ICR benefit to include the Benson-Henry Institute Cardiac Wellness Program. This change request is effective for dates of service on and after May 6, 2014. CMS also released a related revision to the Medicare National Coverage Determinations Manual. An NCD that expands coverage is binding on a Medicare advantage organization. In addition, an ALJ may not review an NCD.
 
Effective date: May 6, 2014
Implementation date: November 4, 2014
 
View Transmittal R3084CP.
 
View Transmittal R175NCD.
 
CMS’ Five Star Quality Rating System for nursing homes
 
On October 6, CMS released a fact sheet regarding Five Star Quality Rating System for Nursing Homes, a consumer service that offers useful information to the public about the quality of care in the 15,800 nursing homes that participate in the Medicare or Medicaid programs. Users may sort through nursing homes in their area through an online tool at CMS’ Nursing Home Compare website (http://www.medicare.gov/nursinghomecompare/search.html).
 
View the fact sheet.
 
View the related press release.
 
Ambulance inflation factor for CY 2015 and productivity adjustment
 
On October 7, CMS released a transmittal manualizing the ambulance inflation factor (AIF) so that Medicare contractors can accurately determine payment amounts for ambulance services. This Recurring Update Notification applies to Pub. 100-04, Medicare Claims Processing Manual, Chapter 15, section 20.4. Transmittal 3057, dated August 29, 2014, is being rescinded and replaced by Transmittal 3090 to update the Multifactor Productivity Adjustment. All other information remains the same.
 
Effective date: January 1, 2015
Implementation date: January 5, 2015
 
View Transmittal R3090CP.
 
Medicare beneficiaries paid nearly half of the costs for outpatient services at critical access hospitals (CAH)
 
On October 8, OIG posted a report regarding CAH certification was created to ensure that rural beneficiaries would have access to hospital services. Medicare reimburses CAHs at 101% of their "reasonable costs," rather than at the predetermined rates set by the OPPS. The system Medicare uses to calculate outpatient coinsurance amounts for beneficiaries who receive services at CAHs differs from that used for beneficiaries who receive services at acute care hospitals. Beneficiaries who receive services at CAHs pay coinsurance amounts based on CAH charges, whereas beneficiaries who receive services at acute care hospitals pay coinsurance amounts based on OPPS rates. CAH charges are typically higher than the reasonable costs associated with CAH services or the OPPS rates acute-care hospitals receive.
 
View the report.
 
Updated information regarding hospital appeals settlement offer
 
On October 8, CMS updated the information available regarding the hospital appeals settlement offer. The change is regarding proper completion of the Eligible Claims Spreadsheet.
 
View the update.
 
CoP for HHA
 
On October 9, CMS posted a proposed rule in the Federal Register which would revise the current CoPs that HHAs must meet in order to participate in the Medicare and Medicaid programs. The proposed requirements would focus on the care delivered to patients by HHAs, reflect an interdisciplinary view of patient care, allow HHAs greater flexibility in meeting quality care standards, and eliminate unnecessary procedural requirements. These changes are an integral part of our overall effort to achieve broad-based, measurable improvements in the quality of care furnished through the Medicare and Medicaid programs, while at the same time eliminating unnecessary procedural burdens on providers. Comments are due December 8.
 
View the notice in the Federal Register.
 
View the fact sheet.
 
View the related press release.
 
Leave a comment.
 
National Coverage Analysis (NCA) for screening for Colorectal Cancer-Stool DNA testing
 
On October 9, CMS posted a final decision memorandum stating the evidence is sufficient to cover CologuardTM – a multitarget stool DNA test – as a colorectal cancer screening test for asymptomatic, average risk beneficiaries, aged 50 to 85 years.  
 
View the final decision memorandum.

CY 2015 inpatient hospital deductible and hospital and extended care services coinsurance amounts
 
On October 10, CMS posted a notice in the Federal Register announcing the inpatient hospital deductible and the hospital and extended care services coinsurance amounts for services furnished in CY 2015 under Medicare’s Hospital Insurance Program (Medicare Part A). The
Medicare statute specifies the formulae used to determine these amounts. For CY 2015, the inpatient hospital deductible will be $1,260. The daily coinsurance amounts for CY 2015 will be: (1) $315 for the 61st through 90th day of hospitalization in a benefit period; (2) $630 for lifetime reserve days; and (3) $157.50 for the 21st through 100th day of extended care services in a skilled nursing facility in a benefit period. This is effective January 1, 2015.
 
View the notice in the Federal Register.
 
CY 2015 Part A premiums for the uninsured aged and for certain disabled individuals who have exhausted other entitlement
 
On October 10, CMS posted an annual notice in the Federal Register announcing Medicare’s Hospital Insurance (Part A) premium for uninsured enrollees in calendar year CY 2015. This premium is paid by enrollees age 65 and over who are not otherwise eligible for benefits under Medicare Part A and by certain disabled individuals who have exhausted other entitlement. The monthly Part A premium for the 12 months beginning January 1, 2015, for these individuals will be $407. The premium for certain other individuals as described in this notice will be $224.
 
View the notice on the Federal Register.
 
Medicare Part B monthly actuarial rates, premium rate, and annual deductible
 
On October 10, CMS posted a notice in the Federal Register announcing the monthly actuarial rates for aged (age 65 and over) and disabled (under age 65) beneficiaries enrolled in Part B of the Medicare Supplementary Medical Insurance program beginning January 1, 2015. In addition, this notice announces the monthly premium for aged and disabled beneficiaries as well as the income-related monthly adjustment amounts to be paid by beneficiaries with modified adjusted gross income above certain threshold amounts.
 
View the notice on the Federal Register.



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