Health Information Management

The week in Medicare updates

APCs Insider, March 14, 2014

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April 2014 update of the OPPS
On February 28, CMS issued a recurring update notification that describes changes to and billing instructions for various payment policies implemented in the April 2014 OPPS update. 
Effective date: April 1, 2014
Implementation date: April 7, 2014 
View Transmittal R2894CP. 
View related MLN Matters® article MM8653. 
 
Quarterly CCI edit update, version 20.2, effective July 1, 2014  
On February 28, CMS issued a recurring update notification that applies to the Medicare Claims Processing Manual, Chapter 23, section 20.9. 
Effective date: July 1, 2014
Implementation date: July 7, 2014 
View Transmittal R2892CP.  
View related MLN Matters article MM8558. 
 
CMS posts instructions for downloading the Medicare ZIP code file for July 2014
On February 28, CMS issued a change request to provide instruction for updating the two Medicare ZIP code files (ZIP5 and ZIP9) for the July 2014 quarter. 
Effective date: July 1, 2014
Implementation date: July 7, 2014 
View Transmittal R2891CP.
 
CMS adds information on HPSA post-payment review process
On February 28, CMS issued a change request that adds information on the post-payment review process for the Health Professional Shortage Area (HPSA) bonus that was previously confidential to the Internet-only manual. 
Effective date: March 31, 2014
Implementation date: March 31, 2014 
View Transmittal R2890CP.
 
CEM code set update 
On February 28, CMS issued a change request to direct the Medicare shared system maintainers to obtain the most recent external code sets, and use them to update the necessary tables and/or reference files as part of the Common Edits and Enhancements Module (CEM) software used by the A/B MACs. 
Effective date: July 1, 2014
Implementation date: July 7, 2014 
View Transmittal R2889CP. 
 
Less than half of Part D sponsors voluntarily reported data on potential fraud and abuse
On March 3, the OIG released a report detailing its findings that more than half of Part D plan sponsors did not report data on potential fraud and abuse between 2010 and 2012. Of those sponsors that did report data, more than one-third did not identify any incidents for at least one of their reporting years. 
View the report.



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