Corporate Compliance

This week in Medicare updates

Medicare Insider, April 28, 2015

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Notice of new interest rate for Medicare overpayments and underpayments-Third quarter notification for FY 2015
 
On April 13, CMS released a transmittal regarding the quarterly interest rate for Medicare overpayments and underpayments. Medicare Regulation 42 CFR Section 405.378 provides for the charging and payment of interest on overpayments and underpayments to Medicare providers. Interest is assessed on delinquent debts to protect the Medicare Trust Funds. The attached recurring update notification applies to Chapter 3, Medicare Financial Management, section 10.
 
Effective date: April 17, 2015
Implementation date: April 17, 2015

View Transmittal R250FM.
 
Supplemental Security Income (SSI)/Medicare beneficiary data for FY 2012 for IPPS hospitals, inpatient rehabilitation facilities (IRF), and long term care hospitals (LTCH)
 
On April 17, CMS released instructions to provide updated data for determining the disproportionate share adjustment for IPPS hospitals and the low-income patient adjustment for IRFs. The SSI/Medicare beneficiary data for hospitals are available electronically and contains the name of the hospital, CMS certification number, SSI days, total Medicare days, and the ratio of Medicare Part A patient days attributable to SSI recipients.
 
Effective date: May 18, 2015
Implementation date: May 18, 2015
 
View Transmittal R1488OTN.
 
View MLN Matters article MM8835.
 
Clarification of ordering and certifying documentation maintenance requirements
 
On April 17, CMS released a change request to clarify the term "access to documentation" in Chapter 15, Medicare Program Integrity, section 15.18, of Pub. 100-08.
 
Effective date: July 20, 2015
Implementation date: July 20, 2015

View Transmittal R587PI.
 
View MLN Matters article MM9112.
 
Update to Remittance Advice Remark and Claims Adjustment Reason Codes, Medicare Remit Easy Print, and PC Print
 
On April 17, CMS released a change request to update the Claim Adjustment Reason Code and Remittance Advice Remark Code lists and also instructs VIPs and Fiscal Intermediary Standard System to update Medicare Remit Easy Print (MREP) and PC Print. This recurring update notification applies to Chapter 22, Medicare Claims Processing Manual, sections 40.5, 60.1, and 60.2.
 
Effective date: July 1, 2015
Implementation date: July 6, 2015
 
View Transmittal R3236CP.
 
View MLN Matters article MM9125.
 
SNF PPS and consolidated billing for FY 2016, SNF Value-Based Purchasing Program, SNF Quality Reporting Program, and Staffing Data Collection
 
On April 20, CMS posted a proposed rule in the Federal Register that would update the payment rates used under the SNF PPS for FY 2016. In addition, it includes a proposal to specify a SNF all-cause all-condition hospital readmission measure, as well as a proposal to adopt that measure for a new SNF Value-Based Purchasing (VBP) Program and a discussion of SNF VBP Program policies being considered for future rulemaking to promote higher quality and more efficient healthcare for Medicare beneficiaries. Additionally, this proposed rule proposes to implement a new quality reporting program for SNFs as specified in the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act). It also would amend the requirements that a long-term care facility must meet to qualify to participate as a SNF in the Medicare program or a nursing facility in the Medicaid program. These requirements implement the provision in the Affordable Care Act regarding the submission of staffing information based on payroll data. Comments are due by June 19.
 
View the notice in the Federal Register.
 
Leave a comment.
 
Practical guidance for healthcare governing boards on compliance oversight
 
On April 20, the OIG and other industry leaders released an educational resource regarding compliance oversight for healthcare governing boards. In addition to governing boards of healthcare organizations, the document will also assist internal auditors, lawyers, and compliance officers that report to those boards. This resource highlights the complementary roles of the internal audit, compliance, and legal functions in any comprehensive compliance program.
 
View the resource.
 
View the story.
 
Physicians and other practitioners reported on Part A critical access hospital (CAH) claims
 
On April 21, CMS released a special edition MLN Matters article reminding billing staff that for CAHs, Method II claims submitted to Medicare must contain an attending or rendering physician or non-physician practitioner who has a valid NPI, is of an eligible specialty, and is enrolled in Medicare in an approved status. Failure to list a physician or non-physician practitioner in the attending or referring fields who meet the above requirements will result in the rejection of the CAH Methods II claim.
 
View special edition MLN Matters article SE1505.
 
Wolters Kluwer clinical drug information Lexi-Drugs compendium revision request
 
On April 21, CMS posted a notice that Wolters Kluwer requested the formal addition of Lexi-Drugs to the list of compendia used by the Medicare program in the determination of a "medically accepted indication" for off-label drugs and biologics used in an anticancer chemotherapeutic treatment regimen. The public comment period begins the date of this posting and ends after 30-calendar days. CMS considers all public comments and is particularly interested in feedback on the addition of Lexi-Drugs to this list of compendia.
 
View the notice.
 
View the Anti-Cancer compendia.
 
Leave a comment.
 
April 2015 OPPS update
 
On April 22, CMS released a recurring update notification with changes to and billing instructions for various payment policies implemented in the April 2015 OPPS update. The April 2015 Integrated OCE (I/OCE) and OPPS Pricer will reflect the HCPCS, APC, HCPCS Modifier, and Revenue Code additions, changes, and deletions identified in this change request. This recurring update notification applies to Chapter 4, Medicare Claims Processing Manual, sections 10.12, 20.6.11, and 180.7. The April 2015 revisions to I/OCE data files, instructions, and specifications are provided in the forthcoming April 2015 I/OCE change request. Transmittal 3235, dated April 14, is being rescinded and replaced by Transmittal 3238 to correct references to the tables. All other information remains the same.
 
Effective date: April 1, 2015
Implementation date: April 6, 2015
 
View Transmittal R3238CP.
 
Manual updates to clarify physician certification and recertification requirements for home health services eligibility
 
On April 22, CMS released a change request manualizing policies discussed in the CY 2015 home health PPS final rule published November 6, 2014. These policies relate to the requirements for physician certification and recertification of patient eligibility for Medicare home health services. This change request also updates the timeframe required for therapy functional reassessments and makes various editorial changes throughout Chapter 7, Medicare Benefit Policy. Transmittal 207, dated April 10, is rescinded and replaced by Transmittal 208 to revise the effective date of the change. Transmittal 91, dated April 10, 2015, is rescinded and replaced by Transmittal 92 to revise the effective date of the change. All other information remains the same.
 
Effective date: January 1, 2015
Implementation date: May 11, 2015
 
View Transmittal R208BP.
 
View Transmittal R92GI.
 
Participation continues to rise in Medicare Physician Quality Reporting System and Electronic Prescribing Incentive Program
 
On April 23, CMS released the 2013 Physician Quality Reporting System (PQRS) and Electronic Prescribing (e-prescribing) Incentive Program Experience Report, which provides data and trends on participation, incentive eligibility, incentive payments, and payment adjustments since the beginning of the programs.   
 
View the fact sheet.
 
Proposed FY 2016 payment and policy changes for Medicare IRFs
 
On April 23, CMS issued a proposed rule outlining proposed FY 2016 Medicare payment policies and rates for the IRF PPS and the IRF Quality Reporting Program (IRF QRP). The FY 2016 proposals are summarized below.
 
View the proposed rule in the Federal Register.
 
View the fact sheet.
 
Quarterly listing of program issuances—January through March 2015
 
On April 24, CMS posted a quarterly notice in the Federal Register listing CMS manual instructions, substantive and interpretive regulations, and other Federal Registernotices that were published from January through March 2015, relating to the Medicare and Medicaid programs and other programs administered by CMS.
 
View the notice in the Federal Register.
 
Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) meeting
 
On April 24, CMS posted a notice in the Federal Register announcing a public meeting of the MEDCAC will be held on Wednesday, July 22, 2015, at 7:30 a.m. Eastern. This meeting will specifically focus on lower extremity peripheral artery disease. This meeting is open to the public.
 
View the notice in the Federal Register.
 
Register for the event.
 
Leave a comment.



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