Corporate Compliance

This week in Medicare updates

Medicare Insider, July 14, 2015

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ESRD PPS and Quality Incentive Program (QIP)

On July 1, CMS posted the ESRD PPS proposed rule in the Federal Register. It is to update and make revisions ESRD PPS for calendar year (CY) 2016. The proposals in this rule are necessary to ensure that ESRD facilities receive accurate Medicare payment amounts for furnishing outpatient maintenance dialysis treatments during CY 2016. This rule also proposes to set forth requirements for the ESRD QIP for CY 2016. In an effort to incentivize ongoing quality improvement among eligible providers, the ESRD QIP proposes to establish and revise requirements for quality reporting and measurement, including the inclusion of new quality measures for payment year (PY) 2019 and beyond and updates to programmatic policies for the PY 2017 and PY 2018 ESRD QIP.

View the proposed rule in the Federal Register.

Leave a comment.


Part D plans generally include drugs commonly used by dual eligibles: 2015

On July 1, the OIG posted a memorandum to fulfill the annual reporting mandate from the Patient Protection and Affordable Care Act (ACA) for 2015. The ACA requires that the OIG conduct a study of the extent to which formularies used by stand-alone prescription drug plans and Medicare Advantage prescription drug plans (referred to jointly as Part D plans) under Medicare Part D include drugs commonly used by full-benefit dual-eligible individuals (i.e., individuals who are eligible for both Medicare and full Medicaid benefits).

View the memorandum.

Improvements are needed in SNF billing for changes in therapy

On July 1, the OIG posted a report detailing a study in which it used SNF claims to analyze billing for changes in therapy from fiscal years 2010 through 2013. The OIG also determined whether, under the new policies, SNFs used assessments differently when decreasing therapy than when increasing it. Lastly, we determined the extent to which SNFs used the new assessments incorrectly.

View the report.

Tester resolution reports for ICD-10 limited end-to-end testing with submitters

On July 2, CMS rescinded Transmittal 1481, dated March 27, 2015, and replaced it with Transmittal 1517 to remove the requirement for report files to be password protected and clarify how files shall be sent to CMS. All other information remains the same. The original transmittal requires MACs to produce a report for each tester that provides the final status of each claim that was submitted.

Effective date: April 27, 2015
Implementation date: May 29, 2015

View Transmittal R1517OTN.

Medicare Internet Only Manual Publication 100-04 Chapter 22 Remittance Advice

On July 2, CMS released a change request to modify the current version of Pub. 100-04, Medicare Claims Processing Manual, Chapter 22-Remittance Advice to remove outdated information. Additional clarification of instruction has been added to this chapter.

Effective date: August 3, 2015
Implementation date: August 3, 2015

View Transmittal R3288CP.

Corrected Medicare Part A SNF PPS pricer update FY 2016

On July 2, CMS rescinded Transmittal 3286, dated June 26, 2015, and replaced it with Transmittal 3289 to correct a typo in the business requirements; "FY 2015" was corrected to read "FY 2016". All other information remains the same.

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

View Transmittal R3289CP.

View MLN Matters article MM9222.

Medicare contractor overpaid provider that incorrectly billed for Aflibercept

On July 6, the OIG posted a report stating that Wisconsin Physicians Service Insurance Corporation, a Medicare contractor for Iowa, Kansas, Missouri, and Nebraska, overpaid a provider that incorrectly billed for aflibercept by $432,000.

View the report.

CMS and AMA announce efforts to help providers get ready for ICD-10

On July 6, CMS posted a press release announcing efforts to continue to help physicians get ready ahead of the October 1 deadline for ICD-10 implementation. In response to requests from the provider community, CMS stated it is releasing additional guidance that will allow for flexibility in the claims auditing and quality reporting process as the medical community gains experience using the new ICD- 10 code set.

View the press release.

Proposed policy, payment, and quality provisions changes to the Medicare Physician Fee Schedule for CY 2016

On July 8, CMS posted a proposed rule that updates payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2016. This year, CMS is proposing a number of new policies, including several that are a result of recently enacted legislation. The rule also finalizes changes to several of the quality reporting initiatives that are associated with PFS payments, including the Physician Quality Reporting System, the Physician Value-Based Payment Modifier (Value Modifier), and the Medicare EHR Incentive Program, as well as changes to the Physician Compare website on Medicare.gov.

View the proposed rule.

View the fact sheet.

View the press release.

Comprehensive Care for Joint Replacement

CMS posted a proposed rule in the Federal Register regarding a new Comprehensive Care for Joint Replacement model meant to address the fragmentation present in the current system when a beneficiary requires a joint replacement by focusing on coordinated, patient-centered care. This model aims to improve the care experience for the many and growing numbers of Medicare beneficiaries who receive joint replacements and places the patient’s successful surgery and recovery as the top priority of the healthcare system.

View the proposed rule in the Federal Register.

View the fact sheet.

National coverage analysis (NCA) for screening for cervical cancer with Human Papillomavirus (HPV) testing

On July 9, CMS posted a final decision memorandum stating that the evidence is sufficient to add HPV testing once every five years as an additional preventive service benefit under the Medicare program for asymptomatic beneficiaries aged 30 to 65 years in conjunction with the Pap smear test. CMS will cover screening for cervical cancer with the appropriate FDA approved/cleared laboratory tests, used consistent with FDA approved labeling and in compliance with CLIA regulations.

View the decision memorandum.

CY 2016 Home Health PPS (HH PPS) rate update; Home health value-based purchasing model; and home health quality reporting requirements

On July 10, CMS posted a proposed rule in the Federal Register. This proposed rule would
update HH PPS rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply conversion factor, effective for episodes ending on or after January 1, 2016. This rule proposes reductions to the national, standardized 60-day episode payment rate in CY 2016 and CY 2017 of 1.72% in each year to account for estimated case-mix growth unrelated to increases in patient acuity; a home health value-based purchasing model in which all Medicare-certified HHAs in selected states will be required to participate; changes to the home health quality reporting program requirements; and would update the HH PPS case-mix weights. Comments are due by September 4.

View the proposed rule in the Federal Register.

View the fact sheet.

View the press release.
 



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