Corporate Compliance

This week in Medicare updates

Medicare Insider, February 17, 2015

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Updated implementation date for laboratory travel allowance fee
On February 5, CMS rescinded and replaced a transmittal released in January on the Laboratory Travel Allowance to update the implementation date.
Effective date: January 1, 2015
Implementation date: As soon as possible, but no later than April 24, 2015
View Transmittal R3189CP.
RAC specific “No Documentation” medical necessity denial reason code
On February 6, CMS released a change request to provide a Recovery Audit specific "No documentation" reason code for MACs to append to prepayment claim denials.
Effective date: July 1, 2015
Implementation date: July 6, 2015 for Define/Analyze and Design Application; October 5, 2015 for Hours for Code Development/Test and Alpha Testing
View Transmittal R1462OTN.
Oncology Care Model
On February 12, CMS posted a fact sheet regarding its development of new payment and service delivery models that will improve quality and reduce the cost of specialty care. The Oncology Care Model (OCM) is the second specialty care model to be announced. OCM is an innovative multi-payer model in which practices enter into payment arrangements that include financial and performance accountability for episodes of care surrounding chemotherapy administration to cancer patients.  This model aims to provide higher quality, more highly coordinated oncology care at a lower cost. OCM is a five-year model and will begin in spring 2016.
View the fact sheet.
View the press release.
Advisory opinion regarding the effect of exclusion from Medicare, Medicaid, and all other Federal healthcare programs
On February 13, OIG posted Advisory Opinion 15-02. This advisory opinion is regarding exclusion from federal healthcare programs.
View the report.

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