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The week in Medicare updates

HIM-HIPAA Insider, November 18, 2013

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The Coordination of Benefits Contractor (COBC) to remove and no longer apply federal tax information received through the IRS, Social Security Administration (SSA), CMS Medicare Secondary Payer (MSP) Data Match Program on the Common Working File (CWF)

On November 6, CMS issued a change request to inform Medicare contractors that the COBC will remove federal tax information from all employer fields in the MSP auxiliary file that was created by contractor number 77777 and 11102 beginning in October 2013. Medicare contractors shall delete all employer information created by CWF contractor number 77777 or 11102 from their internal files if not done so by CWF. No other employer fields found in MSP records created outside of the IRS/SSA/CMS data match project will be affected. All other MSP information housed in the MSP auxiliary record will not be removed.

Implementation date: April 7, 2014

Reassignment to Part A Critical Access Hospitals (CAH) billing under Method II (CAH II)

On November 7, CMS issued a rescind and replace transmittal to: (1) Explain the purpose of this change request, (2) Remove federally qualified health centers and rural health clinics as entities eligible to accept reassignments, and (3) Clarify that Part A reassignments only apply to CAHs billing under Method II (CAH II) Also, since all legacy contractors have now transitioned to MACs, the FIs and Carriers have been unchecked from the business requirements. All other information remains the same.

Implementation date: January 7, 2014

Modifications to the National Coordination of Benefits Agreement (COBA) Crossover Process

On November 7, CMS issued instructions on how to include new indicators that make it possible to identify various high-volume COBA crossover claims that A/B Medicare Administrative Contractors (MAC) and Durable Medical Equipment MACs created following CMS-directed claims reprocessing actions. An additional scenario that merits a systems change is also addressed in this instruction.

Implementation date: April 7, 2014

CWF and FISS Informational Unsolicited Response or denial of inpatient services related to a hospice terminal diagnosis

On November 7, CMS issued a transmittal to instruct the Common Working File (CWF) and Fiscal Intermediary Standard System (FISS) maintainers to deny an inpatient hospital claim when the principal diagnosis on the inpatient claim matches one of the hospice diagnosis codes. Services related to a hospice terminal diagnosis provided during a hospice period are included in the hospice payment and are not paid separately. An inpatient hospital claim will be denied when providers bill with a condition code 07 on an inpatient claim and the principal diagnosis on the inpatient claim is found to match one of the hospice diagnosis codes.

Implementation date: April 7, 2014

CMS announces new data sharing tool

On November 12, CMS issued a press release announcing the launch of the CMS Virtual Research Data Center at the White House event Data to Knowledge to Action: Building New Partnerships.

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