Health Information Management

The week in Medicare updates

HIM-HIPAA Insider, March 17, 2014

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April 2014 update of the hospital outpatient prospective payment system (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 update to the correct coding initiative (CCI) edits, version 20.2, effective July 1, 2014
 
On February 28, CMS issued a recurring update notification that applies to the Medicare Claims Processing Manual, Pub. 100-04, 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 health professional shortage area (HPSA) post-payment review process
On February 28, CMS issued a change request that adds information on the post-payment review process for the HPSA bonus that was previously confidential to the Internet-only Manual.
 
Effective date: March 31, 2014
Implementation date: March 31, 2014
 
View Transmittal R2890CP.
 
 
Common edits and enhancements modules (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 CEM software utilized 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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