Corporate Compliance

This week in Medicare updates

Medicare Insider, July 7, 2015

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FY 2016 Medicare Part A SNF PPS pricer update

On June 26, CMS released a transmittal to provide information on the updates to the payment rates used under the PPS for SNFs, for FY 2016, as required by statute. The update can be found in Chapter 6, Section 30.7 of the Medicare Claims Processing Manual.

Effective date: October 1, 2015
Implementation date: October 5, 2015

View Transmittal R3286CP.

View MLN Matters article MM9222.

CMS proposed updates to policies and payment rates for ESRD Facilities for calendar year (CY) 2016 and proposed changes to the ESRD Quality Incentive Program

On June 26, CMS posted a fact sheet regarding a proposed rule that will update payment policies and rates under the ESRD PPS for renal dialysis services furnished to beneficiaries on or after January 1, 2016. This rule also proposes new quality and performance measures to improve the quality of care by dialysis facilities treating patients with end-stage renal disease.

View the fact sheet.

Clarification of critical access hospital (CAH) rural status, location, and distance requirements

On June 26, CMS posted a memorandum superseding the portion of the guidance of policy memorandum S&C 11-33 which addresses metropolitan statistical areas. That guidance is being updated to reflect the new CAH regulation at 42 CFR 485.610(b)(5). Under the new regulation, a Medicare-participating CAH previously located in a rural area may no longer be located in a rural area when CMS adopts the most recent Office of Management and Budget (OMB) delineations. Such CAHs are permitted to retain their CAH status up to two years from the effective date of CMS’ latest adoption of the OMB delineations. During this grace period, the CAHs are expected either to reclassify as rural under one of the alternatives or to convert to a Medicare-participating hospital. The guidance found in Chapter 2 and Appendix W of the State Operations Manual (SOM) is being updated to specify that the proximity to each other of Indian Health Services (IHS)/Tribal hospitals/CAHs and non-IHS/Tribal hospitals/CAHs is not considered when a CAH location determination is made. The guidance in Chapter 2 and Appendix W of the SOM is also being updated to reflect the location and distance requirements relative to CAHs located on islands. The criteria for a primary road have been refined.

View the survey and certification letter.

Use of portable Reverse Osmosis (RO) units and block carbon

On June 26, CMS posted a survey and certification letter regarding portable RO units that meet Association for the Advancement of Medical Instrumentation water quality standards, as incorporated by reference in the ESRD Condition for Coverage (CfC) at 42 CFR Section 494.40, may be used in outpatient dialysis facilities. ESRD Surveyors should follow the ESRD Core Survey process in conjunction with this guidance for use of portable RO units and block carbon in outpatient dialysis facilities.

View the survey and certification letter.

SAMHSA improved outcome reporting for the Substance Abuse Prevention and Treatment Block grant

On June 29, the OIG posted a report stating SAMHSA leads public health efforts to improve the quality and availability of prevention and treatment services for substance abuse and mental illness. One such effort is the Substance Abuse Prevention and Treatment Block Grant (SABG) program, which provides over $1.7 billion each FY to grantees (i.e., states, territories, and tribes) to prevent and treat substance abuse. In 2003, the Office of Management and Budget had rated the SABG program as ineffective and given it a low score on program results and accountability. However, in recent years, SAMHSA reports that it has made significant strides in improving performance and outcome measurement for its block grant programs, including the SABG program.

View the report.

Revisions to Medicare Claims Processing Manual for foreign, emergency, and shipboard claims

On June 30, CMS rescinded Transmittal 3199 and replaced it with Transmittal 3287 to re-designate sections 340 & 350 to sections 350 & 360, respectively. All other information remains the same. This change request revises the instruction found in the Medicare Claims Processing Manual for processing foreign, emergency, and shipboard claims.

Effective date: April 21, 2015
Implementation date: April 21, 2015

View Transmittal R3287CP.

Medicare Compliance Review of the University of Kentucky HealthCare for 2011 and 2012

On June 30, the OIG posted a report detailing a Medicare Compliance Review of the University of Kentucky HealthCare that found the hospital complied with Medicare billing requirements for 154 of the 232 inpatient and outpatient claims that it reviewed. However, the hospital did not fully comply with Medicare billing requirements for the remaining 78 claims, resulting in overpayments of $209,000.

View the complete report.

CY 2016 proposed hospital OPPS rule

On July 1, CMS released CMS-1633-P, the CY 2016 hospital OPPS and ASC payment system policy changes, quality provisions, and payment rates proposed rule. It proposes updates to Medicare payment policies and rates for hospital outpatient departments, ASCs, and partial hospitalization services provided by community mental health centers, and changes that encourage high-quality care in these outpatient settings. This proposed rule also includes important proposed changes to the 2-midnight rule for CY 2016. Comments are due August 31.

View CMS-1633-P.

View the fact sheet.

View the fact sheet on the 2-midnight rule.

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