Corporate Compliance

This week in Medicare updates

Medicare Insider, September 15, 2015

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Update to hospice payment pates, cap, wage index and Pricer for FY 2016

On September 4, CMS released a change request updating the hospice payment rates, hospice wage index, and Pricer for FY 2016. It also updates the hospice cap amount for the cap year ending October 31, 2015.

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

View Transmittal R3345CP.

View MLN Matters article MM9301.

State Operations Manual (SOM), Section 2185- HHAs, change of address to a MAC within 90 days

On September 4, CMS released a change request revising the SOM at Section 2185 to specify that when an existing HHA intends to move from its surveyed and certified location to a new site or location that is within the current approved geographic area, it notifies its MAC within 90 days of the move, and submits all required documentation including an amended Form CMS -855A.

Effective date: September 4, 2015
Implementation date: September 4, 2015

View Transmittal R146SOMA.

2015–2016 influenza resources for healthcare professionals

On September 8, CMS released a special edition MLN Matters article containing resources for healthcare professionals providing influenza vaccines to Medicare beneficiaries. It includes educational and billing information.

View MLN Matters article SE1523.

2016 Physician Quality Reporting System (PQRS) payment adjustment

On September 9, CMS released a fact sheet regarding PQRS, a quality reporting program that uses negative payment adjustments to promote reporting of quality information by individual eligible professionals (EP), EPs providing services at a critical access hospital (CAH) billing under method II, and PQRS group practices participating in the group practice reporting option. Those who do not satisfactorily report data on quality measures for covered Medicare Physician Fee Schedule services furnished to Medicare Part B beneficiaries (including Railroad Retirement Board, Medicare Secondary Payer, and CAH method II) or satisfactorily participate in a qualified clinical data registry will be subject to a negative payment adjustment under PQRS.

View the fact sheet.

Changes to supplier documentation and evidence of medical necessity for oxygen claims

On September 10, CMS released a change request to update the Program Integrity Manual instructions for supplier documentation, continued use and continued need, and evidence of medical necessity.

Effective date: September 29, 2015
Implementation date: September 29, 2015

View Transmittal R612PI.

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