Corporate Compliance

This week in Medicare updates

Medicare Insider, October 28, 2014

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Notice of new interest rate for Medicare overpayments and underpayment
 
On October 14, CMS released a transmittal updating the interest rate applicable for charging interest on overpayments and paying interest on underpayments to Medicare providers. The interest rate rose from 9.625% to 10.75% for payments on or after October 20, 2014.
 
Effective date: October 20, 2014
Implementation date: October 20, 2014
 
View Transmittal R243FM.
 
Update of rules for complex reviews
 
On October 17, CMS released a change request changing the number of days MACs and RACs have to conduct pre- and post-payment complex review from 60 days to 30 days. The transmittal also addressed other review contractors related to qualifications of review staff, inter-rater reliability and Quality Improvement processes
 
Effective date: February 24, 2015
Implementation date: February 24, 2015
 
View Transmittal R547PI.
 
Medicare Coverage of Ultrasound screening for Abdominal Aortic Aneurysms (AAA) and screening Fecal-Occult Blood Tests (FOBT)
 
On October 17, CMS released a change request regarding coverage of ultrasound screening for AAA beyond one year following the Initial Preventive Physical Exam and screening FOBTs ordered by non-physician practitioners.
 
Effective date: January 27, 2014
Implementation date: November 18, 2014
 
View Transmittal R196BP.
 
View Transmittal R176NCD.
 
View Transmittal R3096CP.
 
October update to the CY 2014 Medicare Physician Fee Schedule Database
 
On October 20, CMS rescinded and replaced the October update to the CY 2014 Medicare Physician Fee Schedule final rule to correct the Type of Service indicator for HCPCS code G0471 from a "9" to a "5". All other information remains the same.
 
Effective date: October 1, 2014
Implementation date: October 6, 2014
 
View Transmittal R3097CP.
 
View MLN Matters article MM8888.
 
Reporting supplier’s National Provider Identifier (NPI) on anti-markup and reference laboratory claims
 
On October 21, CMS rescinded and replaced a transmittal on reporting the NPI of the rendering supplier for anti-markup and reference laboratory test claims to correct the effective and implementation date. All other information remains the same.
 
Effective date: January 1, 2015 for analysis, design, and programming; April 1, 2015 for testing and implementation
Implementation date: April 5, 2015 for claims received on or after April 1, 2015
 
View Transmittal R3098CP.
 
View Transmittal MM8806.
 
Transforming Clinical Practice Initiative
 
On October 23, CMS launched a new innovative model to support clinicians in achieving large-scale healthcare transformation. The Transforming Clinical Practice Initiative will provide up to $840 million over the next four years to support 150,000 clinicians in sharing, adapting and further developing comprehensive quality improvement strategies, which are expected to lead to greater improvements in patient health and reduction in health care costs.
 
View the fact sheet.
 
National coverage analysis (NCA) for Microvolt T-wave Alternans
 
On October 23, CMS posted a proposed decision memorandum regarding the NCD on microvolt T-wave alternans (MTWA) diagnostic testing to extend coverage to the modified moving average (MMA) method. CMS' interest in MTWA testing is in the risk stratification of Medicare beneficiaries who may be at risk for sudden cardiac death (SCD). CMS proposes there is insufficient evidence to conclude the MMA method of determining MTWA improves health outcomes for Medicare beneficiaries at risk for SCD and therefore it is not reasonable and necessary.
 
View the proposed decision memorandum.
 
2015 HCPCS annual update reminder
 
On October 24, CMS released a change request announcing the complete HCPCS file update will be available for contractors to download November 3. The file contains existing, new, revised, and discontinued HCPCS codes for 2015.  CMS also posts the HCPCS Level II file on their website.
 
Effective date: January 1, 2015
Implementation date: January 5, 2015
 
View Transmittal R3100CP.
 
View HCPCS Data File Website.
 
2015 fee schedule and pricing data files update reminder
 
On October 24, CMS released a change request announcing the annual update to the various pricing files used by MACs to adjudicate Part B fee schedule claims will be available for download November 14.
 
Effective date: January 1, 2015
Implementation date: January 5, 2015
 
View Transmittal R3099CP.
 
Update regarding Hospital Appeals Settlement offer
 
On October 24, CMS posted updated Frequently Asked Questions regarding the Hospital Appeals Settlement offer.
 
View the Frequently Asked Questions.
 
Use of HCPCS X Modifiers for Distinct Procedural Services
 
CMS released an MLN article related to a prior transmittal establishing four new HCPCS modifiers to define subsets of the 59 modifier, a modifier used to define a “Distinct Procedural Service.” Beginning on January 1, 2015, providers can use the X modifiers if they are currently using modifier 59 for a reason within the published definition of the X modifiers. Providers also have the option to continue using modifier 59 until CMS issues examples of circumstances in which the X modifiers are or are not appropriate. Additional direction on the use of the specific modifiers will be published.
 
View MLN Matters article MM8863.
 
Medicare Quarterly Provider Compliance Newsletter educational tool released
The “Medicare Quarterly Provider Compliance Newsletter [Volume 5, Issue 1]” Educational Tool (ICN 909051) was released and is now available in downloadable format. This educational tool is designed to provide education on how to avoid common billing errors and other erroneous activities when dealing with the Medicare Program. It includes guidance to help healthcare professionals address and avoid the top issues of the particular Quarter.
 
View the newsletter.



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