Corporate Compliance

This week in Medicare updates

Medicare Insider, November 25, 2014

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New timeframe for response to additional documentation requests
 
On November 14, CMS released a change request to update section 3.2.3.2 of Chapter 3 of the Program Integrity Manual to address the new prepayment review timeframe for Additional Documentation Requests (ADRs) submission and to also instruct the Shared Systems Maintainers to produce ADRs to reflect the new change.
 
Effective date: April 1, 2015
Implementation date: April 6, 2015
 
View Transmittal R554PI.
 
View MLN Matters article MM8583.
 
2015 annual update to the therapy code list
 
On November 14, CMS released a change request updating the list of codes that sometimes or always describe therapy services. The additions, changes, and deletions to the therapy code list reflect those made in the CY 2014 and 2015 Healthcare Common Procedure Coding System and Current Procedural Terminology, Fourth Edition.
 
Effective date: January 1, 2015
Implementation date: January 5, 2015
 
View Transmittal R3121CP.
 
View MLN Matters article MM8985.

Therapy cap values for CY 2015
 
On November 14, CMS released a change request to describe the amounts and the policy for outpatient therapy caps for CY 2015. Information related to this recurring update notification can be found in Pub 100-04, Medicare Claims Processing Manual, Chapter 5, Section 10.2.
 
Effective date: January 1, 2015
Implementation date: January 5, 2015
 
View Transmittal R3120CP.
 
View MLN Matters article MM8970.
 
Rural health clinic (RHC) location determination guidance updated
 
CMS Regional Office (RO) survey and certification staff are responsible for making RHC applicant eligibility determinations related to the RHC rural location and shortage area criteria. Although State Survey Agencies (SAs) make preliminary assessments of eligibility when planning their survey schedule, the authority to make a determination may not be delegated to the SA or other non-CMS entities. This memorandum provides instructions on using HRSA’s Data Warehouse with respect to shortage areas, including when it is necessary to contact HRSA for additional information. A determination whether an initial applicant meets the rural and shortage area eligibility criteria may not be made by the RO before it receives a recommendation for enrollment approval by the MAC, based on the MAC’s review of the applicant’s completed Form CMS-855A. The clinic must already be open and operating before the RO may make a determination.
 
View the survey and certification letter.
 
Screening for hepatitis C virus (HCV) in adults
 
On November 19, CMS released a change request rescinding and replacing Transmittal 3063, dated September 5, 2014, regarding coverage of screening for HCV, with Transmittal 3127. Among other changes, rural health clinics and federally qualified health centers and independent laboratories were added as billing entities and instructions were giving to contractors for processing claims prior to January 1, 2015.
 
Effective date: June 2, 2014
Implementation date: January 5, 2015 for non-shared MAC edits and CWF analysis; April 6, 2015 for remaining shared systems edits
 
View Transmittal R3127CP.
 
View Transmittal R177NCD.
 
View the revised MLN Matters article MM8871.
 
Update to Medicare deductible, coinsurance and premium rates for 2015
 
On November 21, CMS released a recurring change request providing instruction for Medicare Contractors to update the claims processing system with the new CY 2015 Medicare rates.
 
Effective date: January 1, 2015
Implementation date: January 5, 2015
 
View Transmittal R89GI.
 
Prior authorization of non-emergent hyperbaric oxygen (HBO) therapy
 
On November 21, CMS posted a notice in the Federal Register announcing a three year Medicare Prior Authorization model for non-emergent hyperbaric oxygen therapy services in the states of Illinois, Michigan, and New Jersey where there have been high incidences of improper payments for these services. The model will begin on March 1, 2015 in these states.
 
View the notice in the Federal Register.
 
Town Hall meeting on FY 2016 applications for new medical services and technology add-on payments
 
On November 21, CMS posted a notice in the Federal Register announcing a Town Hall meeting to discuss FY 2016 applications for add-on payments for new medical services and technologies under the hospital IPPS. Interested parties are invited to this meeting to present their comments, recommendations, and data regarding whether the FY 2016 new medical services and technologies applications meet the substantial clinical improvement criterion. The Town Hall
Meeting will be held on Tuesday, February 3, 2015. It will begin at 9 a.m. Eastern Standard Time.
 
View the notice in the Federal Register.
 
Leave a comment.
 
More information and registration.
 
Continued approval of DNV GL-Healthcare (DNV GL) critical access hospital (CAH) Accreditation Program
 
On November 21, CMS posted a final notice in the Federal Register announcing its decision to approve DNV GL— Healthcare (DNV GL) 1 for continued recognition as a national accrediting organization CAH wishing to participate in the Medicare or Medicaid programs. This final notice is effective December 23, 2014, through December 23, 2020.
 
View the notice in the Federal Register.
 
MLN Connects™ National Provider Call-Certifying Patients for the Medicare Home Health Benefit
 
CMS is holding a National Provider Call to provide an overview of certifying patient eligibility for the Medicare home health benefit. It includes an overview of a new requirement for HHAs to obtain documentation from the certifying physician and/or the acute/post-acute care facility's medical record for the patient that served as the basis for the certification of patient eligibility. This new requirement was finalized in the CY 2015 Home Health PPS final rule (CMS-1611-F) effective for home health episodes beginning on or after January 1, 2015.
 
View the story.
 
For more information and registration.
 
Guidance for the public, industry, and CMS staff: coverage with evidence development
 
On November 21, CMS posted a guidance describes the history of coverage with evidence development, its statutory basis, and reflects public comments received on a draft guidance document published on November 12, 2012.  
 
View the guidance.



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