Health Information Management

The week in Medicare updates

HIM-HIPAA Insider, June 2, 2014

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Update to surety bond collection procedures

On May 16, CMS released a change request to incorporate new procedures in CMS Publication 100-08, chapter 15, sections 15.21.7.1 and 15.21.7.1.1 to streamline the surety bond collection process.
 
Effective date: June 17, 2014
Implementation date: June 17, 2014
 
View Transmittal R517PI.
 
View MLN Matters article MM8636.
 
Percutaneous Image-guided Lumbar Decompression (PILD) for Lumbar Spinal Stenosis (LSS)
On May 16, CMS released a change request to assert that effective for claims with dates of service on or after January 9, 2014, PILD is covered by Medicare when provided in a clinical study under section 1862(a)(1)(E) through Coverage with Evidence Development for beneficiaries with LSS who are enrolled in an approved clinical study.
 
Effective date: January 9, 2014
Implementation date: October 6, 2014
 
View Transmittal R2959CP.
 
View Transmittal R167NCD.
 
View MLN Matters article MM8757.
 
July 2014 Integrated Outpatient Code Editor (I/OCE) specifications version 15.2
On May 16, CMS released a notification that provides the Integrated OCE instructions and specifications for the Integrated OCE that will be used under the OPPS and Non-OPPS for hospital outpatient departments, community mental health centers, and all non-OPPS providers. It will also be used for limited services in a home health agency not under the home health prospective payment system or to a hospice patient for the treatment of a non-terminal illness.
 
Effective date: July 1, 2014
Implementation date: July 7, 2014
 
View Transmittal R2957CP.
 
View MLN Matters article MM8764.
 
Modifying the Daily Common Working File (CWF) to Medicare Beneficiary Database File
On May 16, CMS released a change request that instructs the CWF to send up to 25 iterations of diagnosis codes associated with Medicare secondary payer no-fault, liability, and workers’ compensation records for inclusion on HIPAA Eligibility Transaction System 271 response transaction.
 
Effective date: October 1, 2014
Implementation date: October 6, 2014
 
View Transmittal R1386OTN.
 
View MLN Matters article MM8456.
 
Additional states requiring payment edits for DMEPOS suppliers of prosthetics and certain custom-fabricated orthotics
On May 16, CMS released a change request to communicate the three additional states that require the use of a licensed/certified orthotist or prosthetist for furnishing of orthotics or prosthetics. Those states are North Dakota, Iowa, and Pennsylvania.
 
Effective date: March 3, 2014
Implementation date: June 17, 2014
 
View Transmittal R1385OTN.
 
View MLN Matters article MM8730.
 
Posting the limiting charge after applying the electronic health record (EHR) and physician quality reporting system (PQRS) negative adjustments
On May 16, CMS released a change request to place the EHR and PQRS negative adjustment limiting charge amounts on contractor websites and hardcopy disclosure reports.
 
Effective date: January 1, 2014
Implementation date: October 6, 2014
 
View Transmittal R1384OTN.
 
View MLN Matters article MM8667.
 
Information for applications to extend the due date for the installation of automatic sprinkler systems in existing nursing homes
On May 16, CMS posted a memorandum regarding a final rule Part II--Regulatory Provisions To Promote Program Efficiency, Transparency, and Burden Reduction (CMS-3267-F) to permit a very limited extension of the automatic sprinkler due date for a facility that is building a replacement facility or undergoing major modifications to unsprinklered living areas.
 
View the survey and certification letter.
 
Grant solicitation for the reinvestment of federal civil money penalty (CMP) funds to benefit nursing home residents
On May 16, CMS announced it is soliciting proposals for a grant opportunity in which Federal CMP Funds will be used to support and further expand the National Partnership to Improve Dementia Care in Nursing Homes.
 
View the survey and certification letter.
 
CMS mitigating factors process for solid organ transplant programs
On May 16, CMS posted a survey and certification memorandum summarizing only the proposals related to solid organ transplant programs.
 
View the survey and certification letter.
 
Provision of EHR “Navigators” during hospital and Critical access hospital (CAH) surveys
On May 16, CMS posted a memorandum to advise hospitals and CAHs that state survey agency surveyors may be requesting that experienced hospital/CAH EHR users with appropriate system permissions be assigned as “navigators”. Navigators would assist surveyors with medical record information retrieval for survey tasks requiring detailed medical record review. Providing such assistance is analogous to the traditional expectation for paper-based records that hospitals and CAHs retrieve closed paper medical records requested by surveyors, and hospitals/CAHs are expected to provide the necessary assistance to enable surveyors to review EHRs.
 
View the survey and certification letter.
 
OIG regional inspector general delivers testimony about Medicare
On May 20, OIG’s Regional Inspector General for the Office of Evaluation and Inspections, Jodi D. Nudelman, delivered a testimony during the hearing “Current Hospital Issues in the Medicare Program.” Nudelman summarized OIG’s work in three areas that are key to improving the Medicare program: hospital observation and short inpatient stays, Recovery Audit Contractors, and the Medicare appeals process.
 
View the testimony.
 
OIG acting deputy inspector general delivers testimony about Medicare msmanagement
On May 20, OIG’s Acting Deputy Inspector General for Evaluation and Inspections, Brian P. Ritchie, testified during a hearing titled “Medicare Mismanagement: Oversight of the Federal Government Efforts to Recapture Misspent Funds.” Ritchie testified about recommendations to prevent Medicare improper payments, increase recoveries of overpayments, ensure effective performance by contractors, and improve the Medicare appeals process that resolves disputes over improper payments.
 
View the testimony.
 
Interpretive Guidance and procedures for sanitary conditions, preparation of eggs in nursing homes
On May 20, CMS posted a memorandum stating that skilled nursing and nursing facilities should use pasteurized shell eggs or liquid pasteurized eggs to eliminate the risk of residents contracting Salmonella Enteritidis.
 
View the survey and certification letter.
 
Update of State Operations Manual (SOM) Chapter 5, Triaging complaints & referral of complainants to accrediting organizations (AO)
On May 20, a “non-IJ High” category for prioritizing complaint allegations was added to Section 5075 of the SOM for non-long term care. It applies to all substantial allegations of noncompliance (except for immediate jeopardy (IJ) allegations), and requires an SA complaint investigation. All complainants whose complaints concerning deemed providers/suppliers are prioritized below non-IJ High must be referred to the applicable AOs.
 
View the survey and certification letter.
 
Guidance on independent charity patient assistance programs (PAPs) for Federal Health Care program beneficiaries
On May 21, the OIG released a Supplemental Special Advisory Bulletin on PAPs run by independent charities. The OIG announced that this document expands 2005 OIG guidance in response to concerns about potential abuses arising from some PAPs' interactions with their donors.
 
View the bulletin.
 
Contract year 2015 policy and technical changes to the Medicare Advantage (MA) and the Medicare prescription drug benefit programs
On May 22, CMS published a final rule in the Federal Register that will revise the MA program (Part C) regulations and prescription drug benefit program (Part D) regulations to implement statutory requirements; improve program efficiencies; and clarify program requirements. The final rule also includes several provisions designed to improve payment accuracy.
 
View the notice on the Federal Register.
 
View the fact sheet.
 
View the press release.
 
CMS seeks input on prior authorization process for certain durable medical equipment, prosthetics, orthotics and supplies items (DMEPOS)
On May 22, CMS issued a proposed rule that would build on a successful demonstration program and establish a prior authorization process for certain DME, prosthetics, orthotics, and supplies items. Using a prior authorization process will help ensure these DMEPOS are provided efficiently and consistent with the law. The proposed rule aims to prevent unnecessary utilization while ensuring beneficiaries’ access to medically necessary items.
 
View the fact sheet.
 
View the press release.
 
Prior authorization process for repetitive scheduled non-emergent ambulance transport
On May 22, CMS announced it will begin implementing a prior authorization demonstration program for repetitive scheduled non-emergent ambulance transport in New Jersey, Pennsylvania, and South Carolina. CMS will test whether prior authorization helps reduce expenditures, while maintaining or improving quality of care.
 
View the fact sheet.
 
Prior authorization process for non-emergent hyperbaric oxygen therapy
On May 22, CMS announced it will begin implementing a prior authorization demonstration program for non-emergent hyperbaric oxygen therapy in Illinois, Michigan, and New Jersey. CMS will test whether prior authorization helps reduce expenditures, while maintaining or improving quality of care.
 
View the fact sheet.



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