Health Information Management

The week in Medicare updates

APCs Insider, November 22, 2013

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Use of claim adjustment reason (CARC) code 23

On November 14, CMS issued a transmittal instructing the Shared System Maintainers on how to use CARC 23 to report prior payer adjudication in case of a secondary claim.

Effective date: April 1, 2014

Implementation date: April 7, 2014

View Transmittal R1318OTN.

 

Update to Medicare deductible, coinsurance, and premium rates for calendar year (CY) 2014

On November 15, CMS issued a transmittal instructing Medicare contractors on how to update the claims processing system with the new CY 2014 Medicare rates.

Effective date: January 1, 2014

Implementation date: January 6, 2014

View Transmittal R82GI.

View MLN Matters article MM8527.
 

Bariatric surgery for treatment of comorbid conditions related to morbid obesity

On November 15, CMS issued a transmittal stating that, effective for dates of service on and after September 24, 2013, facility certification shall no longer be required for coverage of covered bariatric surgery procedures.

Effective date: September 24, 2013

Implementation date: December 17, 2013

View Transmittal R157NCD.

View Transmittal R2816CP.

 

Immediate suspension of postpayment patient status reviews of inpatient hospital admissions

On November 15, CMS issued a transmittal stating that Medicare Administrative Contractors, Recovery Auditors, and the Supplemental Medical Review Contractor shall not conduct postpayment patient status reviews for inpatient claims with dates of admission October 1, 2013, to December 31, 2013. However, claims with evidence of systematic gaming, abuse, or delays in the provision of care in an attempt to surpass the 2-midnight presumption could warrant medical review at any time.

Effective date: October 1, 2013

Implementation date: December 2, 2013

View Transmittal R1315OTN.

 
Updates to the Medicare Claims Processing Internet-Only Manual

On November 15, CMS issued a transmittal to make various updates to chapters of the Medicare Claims Processing Internet-Only Manual.

Effective date: March 18, 2014

Implementation date: March 18, 2014

View Transmittal R2815CP.

View MLN Matters article MM8490



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