Health Information Management

The week in Medicare updates

HIM-HIPAA Insider, May 5, 2014

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Clarification to Medicare Benefit Policy Manual regarding antigens and deletion of Section 13.14 from Chapter 13 of 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 rescinding and replacing Transmittal R184BP).
Changes to fields in the Inpatient Hospital Provider Specific File (PSF) and Inpatient Prospective Payment System (IPPS) pricer output
On April 17, the inpatient PSF was expanded to include three new fields and an expansion of the existing Model 1 discount percentage field. For clarity, four established payment amount fields will be renamed and four new payment amount fields will be added to the IPPS Pricer Output Record for future use.
Effective date: July 1, 2014
Implementation date: July 7, 2014 
View Transmittal R2933CP (Transmittal is rescinding and replacing transmittal R2870CP).
View MLN Matters article MM8546.
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, Policies and Guidelines Applied During Review. 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.  
CMS changes coverage for fluorodeoxyglucose (FDG) Positron Emission Tomography (PET) for solid tumors
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 FDG 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.
Instructions to contractors for implementing Section 5506 of the Affordable Care Act (ACA)
On April 18, CMS issued a change request for Section 5506 of the ACA, which directed CMS to develop a process to preserve the full-time equivalent resident caps from teaching hospitals that close. This change request addresses the ACA section 5506 Rounds 1, 2, 3, and subsequent rounds.
Effective date: May 19, 2014
Implementation date: May 19, 2014
View Transmittal R1371OTN.
CMS publishes of Notice of Proposed Rulemaking for Fire Safety Requirements
On April 18, CMS published a proposed rule that would amend the current fire safety standards for Medicare- and Medicaid-participating providers and suppliers. This proposed rule would adopt the 2012 edition of the Life Safety Code, National Fire Protection Association, 101. Comments may be accepted until 5 p.m. (Eastern) June 16.
View the Survey and Certification Letter.
CMS releases 2014 OPPS Final Rule Claims Accounting
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 reopens National Coverage Analysis (NCA) 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.
CMS publishes quarterly Medicare and Medicaid program issuances
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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