Corporate Compliance

This week in Medicare updates

Medicare Insider, January 26, 2015

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Medicare Shared Systems modifications necessary to capture various HIPAA compliant fields
 
On January 14, CMS released a change request regarding the need to expand the claim field record used for processing claims information located on the UB-04, or 837I transaction appearing on the claim form. Transmittal 3107, dated November 6, 2014, is being rescinded and replaced by Transmittal 3164 to remove bill types 81x and 82x from Business Requirement 8384.2.4. All other information remains the same.
 
Effective date: April 1, 2015
Implementation date: April 6, 2015
 
View Transmittal R3164CP.
 
View MLN Matters article MM8384.
 
Emergency update to the CY 2015 Medicare Physician Fee Schedule Database (MPFSDB)
 
On January 16, CMS released a change request stating it issued payment files to contractors based on the CY 2015 Medicare Physician Fee Schedule final rule. This change request amends those payment files, including an updated conversion factor of $35.7547 for services furnished between January 1, 2015 and March 31, 2015, consistent with the Protecting Access to Medicare Act of 2014 that provides for a zero percent update from CY 2014 rates. Please note that the work related to this change request has already been done by the Medicare contractors via a previous direction, which was implemented on January 5, 2015. Therefore, the implementation date is prior to the release date of this change request.
 
Effective date: January 1, 2015
Implementation date: January 5, 2015
 
View Transmittal R3166CP.
 
View MLN Matters article MM9081.
 
New additions to State Operations Manual (SOM) psychiatric residential treatment facility (PRTF) Chapter 2
 
On January 16, CMS released two change requests making changes to State Operations Manual (SOM) psychiatric residential treatment facility. One change request made an addition to Chapter 2 of the State Operations Manual, the Certification Process to include sections 2830-2834 detailing the survey process for PRTF. The other change request added Appendix N- PRTF Interpretive Guidance.
 
Effective date: January 16, 2015
Implementation date: January 16, 2015
 
View Transmittal R132SOM.
 
View Transmittal R131SOM.
 
Medicare Managed Care, Chapter 4, Quality Improvement Program
 
On January 16, CMS released a change request stating Medicare Managed Care, Chapter 4 has been revised with new content and clarification of policy in the following areas: hospice coverage, anti-discrimination, review for discrimination and steerage, clinical trials, designation of DME providers/supplies, specifying brands of manufacturers of DME, SNF coverage, cost-sharing standards, missed appointment and related charges, value-added items and services, multiple A/B macs with different policies, rewards and incentives, provider networks, beneficiary protections related to referrals, explanation of benefits, and education members in Medicaid and Medicare. Additionally, the chapter has undergone a reorganization of sections to provide greater clarity.
 
Effective date: January 1, 2015
Implementation date: January 1, 2015
 
View Transmittal R120MCM.
 
Revised State Operations Manual (SOM) Appendix W, critical access hospitals (CAHs)
 
On January 16, CMS posted documentations related to changes for CAH CoPs. CMS-3267-F was published on May 12, 2014 and portions related to CAHs became effective July 11, 2014. Among other provisions, this final rule revised the CAH CoP requirements related to the responsibilities of doctors of medicine and doctors of osteopathy. CMS-1599-F was published August 19, 2013 and became effective October 1, 2013. This final rule revised the CAH CoP requirements related to provision of inpatient acute care services. CMS updated the pertinent portions of the CAH interpretive guidelines, found in SOM Appendix W, to reflect these rule changes. In addition, it updated the guidance for the portions of 42 CFR 485.635 addressing the following topics, in order to bring them into alignment with current accepted standards of practice: pharmacy services; infection prevention and control; dietary services; services under arrangement; nursing services; and rehabilitation services.
 
View the survey and certification letter.
 
ICD-10 limited end-to-end testing with submitters for 2015
 
On January 20, CMS released a change request will allow for MACs to test with a limited number of providers and clearinghouses to ensure claims with ICD-10 codes can be processed from submission to remittance. This additional testing effort will further ensure a successful transition to ICD-10. Transmittal 1426, dated September 12, 2014, is being rescinded and replaced by Transmittal 1451 to incorporate technical direction since the change request’s original issuance, add three Excel spreadsheet attachments, update deliverable dates, and include touch base calls during the testing weeks. Additionally, this change request is no longer Sensitive/Controversial and may be posted to the Internet. All other information remains the same.
 
Effective date: September 12, 2014 for MACs and CEDI (non-systems change requirements) (Note: This is the due date of the first MAC and CEDI requirement); January 26, 2015 for FISS and CEDI coding for January Testing Week; April 27, 2015 for FISS and CEDI coding for April Testing Week; July 20, 2015 for FISS and CEDI coding for July Testing Week
Implementation date: January 5, 2015 for FISS and CEDI coding for January Testing Week; February 16, 2015 for MAC requirements for the January 15 testing. This is the due date of the last MAC deliverable; April 6, 2015 for FISS and CEDI coding for April Testing Week; May 18, 2015 for MAC requirements for the April 15 testing. This is the due date of the last MAC deliverable; July 6, 2015 for FISS and CEDI coding for July Testing Week; August 10, 2015 for MAC requirements for the July 15 testing. This is the due date of the last MAC deliverable.
 
View Transmittal R1451OTN.
 
View MLN Matters article MM8867.
 
Continued approval of the Accreditation Commission for Health Care, Inc. (ACHC); Home Health Agency Accreditation Program
 
On January 20, CMS posted a final notice in the Federal Register announcing its decision to approve the ACHC for continued recognition as a national accrediting organization for home health agencies (HHAs) that wish to participate in the Medicare or Medicaid programs. An HHA participating in Medicaid must also meet the Medicare CoPs as required under 42 CFR 488.6(b). This final notice is effective February 24, 2015 through February 24, 2021.
 
View the notice in the Federal Register.
 
Letter to American Hospital Association regarding OIG’s hospital compliance reviews
 
On January 22, OIG posted a letter written by Gloria Jarmon, Deputy Inspector General for Audit Services for OIG, addressed to Melinda Reid Hatton, Senior Vice President and General Counsel regarding OIG’s hospital compliance reviews.
 
View the letter.
 
Medicare's oversight of compounded pharmaceuticals used in hospitals
 
On January 22, OIG posted a report regarding a review OIG completed on CMS and CMS-approved accreditors’ oversight of compounded-sterile preparations of pharmaceuticals used in acute care hospitals.
 
View the report.
 
Dialysis Facility Compare (DFC) star ratings and data release
 
On January 22, CMS added star ratings to the DFC website. Star ratings can help consumers quickly identify differences in quality and make use of the reporting information when selecting a facility. In addition to summarizing performance, star ratings can help dialysis facilities identify areas for improvement.
 
View the Dialysis Facility Compare website.
 
View the fact sheet.
 
View the press release.
 
Continued Use of Modifier -59 after January 1, 2015
 
On January 22, CMS released a special edition MLN Matters article to clarify the use of modifiers 59, XE, XP, XS, and XU.
 
View special edition MLN Matters article SE1503.
 
Meeting of the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC)
 
On January 23, CMS posted a notice in the Federal Register announcing a public meeting of the MEDCAC will be held on Tuesday, March 24, 2015. The Committee generally provides advice and recommendations concerning the adequacy of scientific evidence needed to determine whether certain medical items and services can be covered under the Medicare statute. This meeting will focus on selected molecular pathology tests for the estimation of prognosis in common cancers. This meeting is open to the public in accordance with the Federal Advisory Committee Act (5 U.S.C. App. 2, section 10(a)). The public meeting will be held on Tuesday, March 24, 2015 from 7:30 a.m. until 4:30 p.m., Eastern. Written comments must be received at the address specified in the ADDRESSES section of this notice by 5 p.m., Eastern, Monday, February 23. Once submitted, all comments are final.
 
View the notice in the Federal Register.
 
Register for the meeting.

 



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