Health Information Management

The week in Medicare updates

APCs Insider, May 2, 2014

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Clarifications made to the Medicare Benefit Policy Manual and Medicare Program Integrity Manual
On April 16, CMS issued a change request that serves to make the Medicare Benefit Policy Manual provisions consistent with regulatory requirements. Additionally, revisions are being made to Chapter 13 of the Program Integrity Manual to accurately reflect CMS’ plan to implement section 731 of the "Medicare Prescription Drug, Improvement and Modernization Act of 2003."
Effective date: January 1, 2001
Implementation date: May 12, 2014 
View Transmittal R186BP (Transmittal is replacing Transmittal R184BP).
  
Revision to the Program Integrity Manual, Chapter 3 Section 3.3
On April 18, CMS issued a change request to update the Program Integrity Manual, Chapter 3, Section 3.3. The update specifies the hierarchy of documents in effect at the time the item(s) or service(s) was provided that government auditors should use to make medical review decisions.
Effective date: May 19, 2014
Implementation date: May 19, 2014 
View Transmittal R512PI.  
 
Fluorodeoxyglucose positron emission tomography for solid tumors coverage update
On April 18, CMS issued a change request effective for claims with dates of service on and after June 11, 2013, CMS shall cover three fluorodeoxyglucose (FDG) positron emission tomography (PET) scans when used to guide subsequent management of anti-tumor treatment strategy after completion of initial anti-cancer therapy for the same cancer diagnosis. The local Medicare Administrative Contractors will determine coverage of any additional FDG PET scans (that is, beyond three) used to guide subsequent management of anti-tumor treatment strategy after completion of initial anti-cancer therapy for the same diagnosis.. 
Effective date: June 11, 2013
Implementation date: May 19, 2014, MAC Non-Shared System Edits; July 7, 2014, CWF development/testing, FISS requirement development; October 6, 2014, CWF, FISS, MCS Shared System Edits. 
View Transmittal R2932CP (This CR rescinds and fully replaces CR8468/TR2873 dated February 6, 2014). 
View MLN Matter article MM8739.
 
2014 OPPS Final Rule claims accounting released
CMS issued a document to provide a detailed overview of its manipulation of the CY 2012 claims data to produce the final prospective CY 2014 OPPS payment rates. This information supports an already detailed discussion of data manipulation in the CY 2014 OPPS/ASC final rule. 
View the document.
 
CMS releases national coverage analysis tracking sheet for Microvolt T-wave Alternans
On April 23, CMS opened a reconsideration of the NCD on Microvolt T-wave Alternans (MTWA) testing. The formal request is to add the modified moving average method of determining MTWA to NCD Manual Section 20.30. The initial 30-day public comment period begins with this posting date, and ends after 30 calendar days. CMS considers all public comments, and is particularly interested in clinical studies and other scientific information relevant to the technology under review. 
View the document. 
View the instructions for submitting comments.
 
Quarterly listing of CMS program issuances: January through March 2014
On April 25, CMS published a quarterly notice that lists its manual instructions, substantive and interpretive regulations, and other Federal Register notices that were published from January through March relating to the Medicare and Medicaid programs and other programs administered by CMS. 
View the document.



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