Corporate Compliance

This week in Medicare updates

Medicare Insider, May 12, 2015

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Identification of Obsolete Shared System Maintainer (SSM) reports - FISS and VMS
 
On May 1, CMS released a change request to identify reports that are obsolete and may be removed from the Fee-For-Service (FFS) applications. The Fiscal Intermediary Shared System (FISS) and ViPS Medicare System (VMS) will identify the reports that still serve a business need and those that are obsolete may be removed from the shared systems.
 
Effective date: October 1, 2015, for VMS; January 1, 2016, for FISS
Implementation date: October 5, 2015, for VMS; January 4, 2016, for FISS
 
View Transmittal R1490OTN.
 
Payments to long-term care hospitals (LTCH) that do not submit required quality data
 
On May 1, CMS released a transmittal stating that, for fiscal year 2014 and each subsequent year, if an LTCH agency does not submit required quality data, their payment rates for the year are reduced by 2% for that fiscal year. Reporting-based reductions to the market basket increase factor will not be cumulative; they will only apply for the FY involved. Every year, CMS will provide Medicare contractors with a letter identifying LTCHs not meeting the quality data reporting requirements. Contractors must update the quality indicator in the Provider Outpatient Specific File for each LTCH subject to the payment reduction.
 
Effective date: September 2, 2015
Implementation date: September 2, 2015
 
View Transmittal R42QRI.
 
View MLN Matters article MM9105.
 
Overview of the repetitive scheduled non-emergent ambulance prior authorization model
 
On May 4, CMS released a special edition MLN Matters article as an educational guide to improve compliance with documentation requirements for the repetitive scheduled non-emergent ambulance prior authorization model. SE1514 provides useful information that will help suppliers receive provisional decisions for prior authorization requests submitted for patients that meet coverage and medical necessity requirements.
 
View special edition MLN Matters article SE1514.
 
Minutes and transcript from MEDCAC meeting posted - Molecular Pathology
 
On May 4, CMS posted minutes and a transcript from the recent Medicare Evidence Development & Coverage Advisory Committee meeting that took place in March to make recommendations concerning selected molecular pathology tests for the estimation of prognosis in common cancers.
 
View the minutes.
 
View the transcript.
 
Questions for MEDCAC meeting posted - Peripheral Artery Disease
 
On May 4, CMS posted questions to the panel for the upcoming Medicare Evidence Development & Coverage Advisory Committee that will take place in July. This MEDCAC meeting will examine the scientific evidence of existing interventions that aim to improve health outcomes in the Medicare population related to lower extremity peripheral artery disease.
 
View the questions.
 
Correction to IPPS proposed rule
 
On May 5, CMS posted a minor correction to a date in the IPPS proposed rule that appeared in the Federal Register on April 30.
 
View the notice in the Federal Register.
 
FY 2016 hospice wage index and payment rate update and hospice quality reporting requirements
 
On May 5, CMS posted a proposed rule in the Federal Register that would update the hospice payment rates and the wage index for FY 2016, including implementing the last year of the phase-out of the wage index budget neutrality adjustment factor (BNAF). This proposed rule also discusses recent hospice payment reform research and analyses and proposes to differentiate payments for routine home care (RHC) based on the beneficiary’s length of stay and to implement a service intensity add-on (SIA) payment for services provided in the last seven days of a beneficiary’s life. Comments are due June 29.
 
View the proposed rule in the Federal Register.
 
Leave a comment.
 
Public meeting July 16 regarding new and reconsidered clinical diagnostic laboratory test codes for the clinical laboratory fee schedule for calendar year (CY) 2016
 
On May 7, CMS posted a notice in the Federal Register announcing a public meeting to receive comments and recommendations for establishing payment amounts for new or substantially revised HCPCS codes being considered for Medicare payment under the clinical laboratory fee schedule (CLFS) for CY 2016.
 
View the notice in the Federal Register.
 
Incorrect place-of-service coding resulted in millions of potential Medicare overpayments
 
On May 8, the OIG posted a report stating physicians did not always correctly code non-facility places of service on Part B claims submitted to, and paid by, Medicare contractors nationwide. The OIG determined that Medicare contractors potentially overpaid physicians approximately $33.4 million for incorrectly coded services provided from January 2010 through September 2012. Physicians performed these services in facility locations, but physicians incorrectly coded the services as performed in non-facility locations.
 
View the report.
 
Recognized presbyopia-correcting (P-C) intraocular lenses (IOL) and astigmatism-correcting (A-C) IOLs
 
On May 8, CMS posted an updated list of recognized P-C and A-C IOLs regarding payment for the insertion of IOLs to replace beneficiaries’ natural lenses following cataract surgery. This list is posted on CMS’ Hospital Outpatient website.
 
View the document.



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