Corporate Compliance

The week in Medicare updates

Medicare Insider, September 1, 2015

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Updates of MS-DRGs to the list subject to IPPS replaced devices offered without cost or with a credit policy
 
On August 19, CMS issued a change request to add MS-DRGs 266 and 267 to the list of MS-
DRGs subject to the policy for replaced devices offered without cost or with a credit and MS-DRGs 237 and 238 have been removed and replaced by new MS-DRGs 268–272. This transmittal is no longer sensitive and is being recommunicated August 19, 2015.
 
Effective date: October 1, 2014; October 1, 2015
Implementation date: October 5, 2015
 
View Transmittal R1494OTN.
 
View MLN Matters article MM9121.
 
Revision to Medicare Code Editor (MCE) edit, procedure inconsistent with length of stay (LOS) for ICD-10-PCS respiratory ventilation, greater than 96 consecutive hours
 
On August 19, CMS issued a change request to ensure correct coding of ICD-10-CM procedure code 5A1955Z, Respiratory ventilation, greater than 96 consecutive hours, by revising the MCE edit for procedure inconsistent with LOS.
 
Effective date: October 1, 2015
Implementation date: October 5, 2015
 
View Transmittal R1495OTN.
 
View MLN Matters article MM9117.
 
Update to Pub. 100-03, National Coverage Determination Manual, Chapter 1, Part 1, Section 50.1 Speech Generating Device
 
On August 21, CMS released a change request providing updates to add a revised scope of benefit national coverage determination for speech-generating devices covered under the Medicare benefit category for Durable Medical Equipment.
 
Effective date: July 29, 2015
Implementation date: September 21, 2015
 
View Transmittal R184NCD.
 
View MLN Matters article MM9281.
 
Healthcare Provider Taxonomy Codes (HPTC) October 2015 code set update
 
On August 21, CMS released a transmittal stating affected Medicare contractors shall obtain the most recent HPTCs code set and use it to update their internal HPTC tables and/or reference files. The attached recurring update notification applies to the Chapter 24, Medicare Claims Processing Manual, Section 60.6.
 
Effective date: October 1, 2015
Implementation date: January 4, 2016 though contractors with the capability to do so shall implement this change request effective October 1, 2015
 
View Transmittal R3336CP.
 
View MLN Matters article MM9260.
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9260.pdf
 
Annual Clotting Factor Furnishing Fee update 2016
 
On August 21, CMS released an annually recurring change request announcing the update to the Clotting Factor Furnishing Fee. This recurring update notification affects Chapter 17, Medicare Claims Processing Manual, § 80.4.1.
 
Effective date: January 1, 2016
Implementation date: January 4, 2016
 
View Transmittal R3340CP.
 
View MLN Matters article MM9295.
 
Update to implement operating rules-Phase III ERA EFT: CORE 360 Uniform Use of Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC) rule
 
On August 21, CMS released a change request instructing the contractors and Shared System Maintainers (SSM) to update systems based on the uniform use of CARC and RARC codes. These system updates are based on the CORE Code Combination List to be published on or about October 1, 2015. This recurring update applies to the entire Medicare Claims processing Manual.
 
Effective date: January 1, 2016
Implementation date: January 4, 2016
 
View Transmittal R3335CP.
 
View MLN Matters article MM9270.
 
October 2015 update of the hospital OPPS
 
On August 21, CMS released a recurring update notification describing changes to and billing instructions for various payment policies implemented in the October 2015 OPPS update. The October 2015 Integrated Outpatient Code Editor (I/OCE) and OPPS Pricer will reflect the HCPCS, APC, HCPCS modifier and Revenue Code additions, changes, and deletions identified in this change request.
 
Effective date: October 1, 2015
Implementation date: October 5, 2015
 
View Transmittal R3333CP.
 
View MLN Matters article MM9298.
 
Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) FY 2016 update
 
On August 21, CMS released a change request identifying changes required as part of the annual IPF PPS update from the FY 2016 IPF PPS Final Rule, published July 31, 2015. These changes are applicable to IPF discharges occurring during fiscal year October 1, 2015, through September 30, 2016.
 
Effective date: October 1, 2015
Implementation date: October 5, 2015
 
View Transmittal R3332CP.
 
View MLN Matters article MM9305.
 
Inpatient Rehabilitation Facility (IRF) Annual Update: PPS Pricer Changes for FY 2016
 
On August 21, CMS released a new IRF PRICER software package will be released prior to October 1, 2015, that will contain the updated rates that are effective for claims with discharges that fall within October 1, 2015, through September 30, 2016.
 
Effective date: October 1, 2015
Implementation date: October 5, 2015
 
View Transmittal R3331CP.
 
ICD-10 Conversion/Coding infrastructure revisions to NCDs
 
On August 21, CMS released the third maintenance update of ICD-10 conversions/updates specific to NCDs. Edits to ICD-10 coding specific to NCDs will be included in subsequent, quarterly updates as needed. No policy-related changes are included with these updates. Any policy-related changes to NCDs continue to be implemented via the current, long-standing NCD process.
 
Effective date: October 1, 2015
Implementation date: January 4, 2016.
Exceptions: FISS will implement the following NCDs April 4, 2016:
  • 260.1
  • 80.11
  • 20.16
  • 270.6
  • 160.18
  • 110.10
  • 110.21
  • 250.5
  • 100.1
  • 160.24
 
View Transmittal R1537OTN.
 
View ZIP files under R1537OTN1.
 
Revisions to Medicare State Operations Manual (SOM), Chapter 9-Exhibits
 
On August 21, CMS released a change request adding New Exhibit 356 added to Chapter 9, Critical Access Hospital (CAH) Recertification Checklist: Rural and Distance or Necessary Provider Verification.
 
Effective date: August 21, 2015
Implementation date: August 21, 2015
 
View Transmittal R145SOM.
 
Medicare Accountable Care Organizations (ACO) provide improved care while slowing cost growth in 2014
 
On August 25, CMS posted a fact sheet regarding 2014 quality and financial performance results showing that Medicare ACOs continue to improve the quality of care for Medicare beneficiaries, while generating financial savings. As the number of Medicare beneficiaries served by ACOs continues to grow, these results suggest that ACOs are delivering higher quality care to more and more Medicare beneficiaries each year.
 
View the fact sheet.

View the press release.
 
CMS payment model initiative to reduce avoidable hospitalizations among nursing facility residents
 
On August 25, CMS posted a fact sheet regarding CMS partnering with seven organizations to implement strategies to reduce avoidable hospitalizations for Medicare-Medicaid enrollees who are long-stay residents of nursing facilities. The Initiative directly supports CMS’ ongoing work to reduce avoidable hospitalizations for Medicare-Medicaid enrollees and improve quality of care in post-acute and long-term care settings. To launch the second phase of this initiative, CMS is announcing a new funding opportunity that will allow currently participating organizations to apply to test whether a new payment model for nursing facilities and practitioners will further reduce avoidable hospitalizations, lower combined Medicare and Medicaid spending, and improve the quality of care received by long-stay nursing facility residents.
 
View the fact sheet.
 
View the press release.
 
Solicitation of nominations to the Advisory Panel on Hospital Outpatient Payment
 
On August 28, CMS posted a notice in the Federal Register soliciting nominations for up to seven new members to the Advisory Panel on Hospital Outpatient Payment. There will be vacancies on this panel for four-year terms that begin during calendar year 2016. The purpose of this panel is to advise the Secretary of HHS and the administrator of CMS on the clinical integrity of the Ambulatory Payment Classification groups and their associated weights, and supervision of hospital outpatient therapeutic services. The Secretary rechartered this panel in 2014 for a two-year period effective through November 6, 2016.
 
View the notice in the Federal Register.



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