Health Information Management

The week in Medicare updates

APCs Insider, May 9, 2014

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Quarterly ASP Medicare Part B drug pricing files released
On April 25, CMS released a transmittal about average sales price (ASP) methodology, which is based on quarterly data submitted to CMS by manufacturers. CMS will supply contractors with the ASP and not otherwise classified drug pricing files for Medicare Part B drugs on a quarterly basis. Payment allowance limits under the OPPS are incorporated into the Outpatient Code Editor through separate instructions that can be located in Chapter 4, section 50 of the Internet-Only Manuals.
 Effective date: July 1, 2014
Implementation date: July 7, 2014
 View Transmittal R2936CP.
 View MLN® Matters MM8748.
OIG releases report on payment and oversight of compounded drugs under Medicare Part B
The Office of the Inspector General (OIG) released a report that indicates neither CMS nor Medicare Administrative Contractors (MAC) tracked the number of claims for compounded drugs under Part B or the corresponding amounts paid, and that Part B claims do not contain information that can be used to systematically identify claims for compounded drugs. OIG also found that claims for compounded drugs do not identify the compounding pharmacy; however, this information may be included in documentation kept by the provider. Finally, OIG found that most MACs manually reviewed Part B claims containing “not otherwise classified” codes, which can represent compounded drugs, to determine payment amounts.
View the report.
OIG deputy inspector general delivers testimony on improving Medicare fraud oversight
On April 30, Gloria L. Jarmon, deputy inspector general for audit services at the OIG, gave testimony at a hearing on improving Medicare oversight to reduce waste, fraud, and abuse. Jarmon said that more action is needed from CMS, its contractors, and the OIG to reduce improper Medicare payments and billing and improve oversight of its Medicare contractors. Reducing improper payments and improving the oversight of contractors are two of the top management and performance challenges and are critical for reducing waste, fraud, and abuse, she said.
View the testimony.
CMS releases final rule including Clinical Laboratory Improvement Amendments
On May 2, CMS released a final rule with comment period to implement methodology and payment rates for a prospective payment system for federally qualified health center services under Medicare Part B beginning on October 1, in compliance with the Affordable Care Act. In addition, it establishes a policy that allows rural health centers to contract with non-physician practitioners when statutory requirements for employment of nurse practitioners and physician assistants are met. It also implements changes to the Clinical Laboratory Improvement Amendment regulations regarding enforcement actions for proficiency testing referrals.
View the document.

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