The week in Medicare updates
APCs Insider, June 6, 2014
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Provider Reimbursement Manual update
On May 23, CMS released a transmittal that updated the Provider Reimbursement Manual, Part 2, Chapter 42, to clarify existing instructions.
Effective dates: Varies
View Transmittal R3PR242.
July 2014 update of the ASC payment system released
On May 23, CMS released a Recurring Update Notification that describes changes to and billing instructions for various payment policies implemented in the July 2014 ASC payment system update. This Recurring Update Notification applies to the Medicare Claims Processing Manual Chapter 14, Section 10.
Effective date: July 1, 2014
Implementation date: July 7, 2014
View Transmittal R2970CP.
Quarterly update to the NCCI edits, Version 20.3
On May 23, CMS released a normal update to the NCCI procedure-to-procedure edits. The Recurring Update Notification applies to the Medicare Claims Processing Manual Chapter 23, Section 20.9.
Effective date: October 1, 2014
Implementation date: October 6, 2014
View Transmittal R2969CP.
Quarterly Update for DMEPOS Competitive Bidding Program (CBP)
On May 23, CMS updated the DME CBP files, as it does on a quarterly basis in order to implement necessary changes to the HCPCS, ZIP code, single payment amount, and supplier files. These requirements provide specific instruction for implementing the DMEPOS CBP files. The Recurring Update Notification applies to the Medicare Claims Processing Manual Chapter 23, Section 100.
Effective date: October 1, 2014
Implementation date: October 6, 2014
View Transmittal R2968CP.
Claim Status Category and Claim Status codes update
On May 23, CMS released an update to the Claim Status category and Claim Status codes. The committee decided to allow the industry six months for implementation of newly added or changed codes.
Effective date: October 1, 2014
Implementation date: October 6, 2014
View Transmittal R2967CP.
Instructions for downloading the Medicare ZIP code file for October 2014
On May 23, CMS released a change request to provide instruction for updating the two Medicare ZIP code files (ZIP5 and ZIP9) for the October 2014 quarter.
Effective date: October 1, 2014
Implementation date: October 6, 2014
View Transmittal R2966CP.
Medicare Claims Processing Manual, Pub. 100-04, Chapter 24 update
On May 23, CMS released a change request to publish an update to Internet-Only Manuals, Medicare Claims Processing Manual, Pub.100-04 Chapter 24, to reflect changes to Medicare Fee-For-Service’s Electronic Data Interchange (EDI) practices, and corresponding EDI requirements for Medicare contractors that are being implemented as part of the 5010 implementation project.
Effective date: July 25, 2014
Implementation date: July 25, 2014
View Transmittal R2965CP.
Common Edits and Enhancements Modules (CEM) code set update
On May 23, CMS released a change request to direct the Medicare shared system maintainers to obtain the most recent external code sets. They are then to use the code sets to update the necessary tables and/or reference files as part of the Common Edits and Enhancements Modules (CEM) software utilized by the A/B MACs. This change became recurring with updates to the Medicare Claims Processing Manual, Chapter 24, Section 50.3.
Effective date: October 1, 2014
Implementation date: October 6, 2014
View Transmittal R2963CP.
ICD-10 conversion/coding infrastructure revisions/ICD-9 updates to NCDs
On May 23, CMS released a maintenance change request, the first maintenance update of ICD-10 conversions and ICD-9 coding updates specific to National Coverage Determinations (NCD). The majority of the NCDs included are a result of feedback received from previous ICD-10 NCD change requests CR7818, CR8109, and CR8197.
Effective date: July 1, 2014 for designated ICD-9 updates and all local system edits; October 1, 2014 for designated ICD-9 shared system edits; October 1, 2015 for all ICD-10 updates (or whenever ICD-10 is implemented)
Implementation date: July 7, 2014 for designated ICD-9 updates and all local system edits; October 6, 2014 for all ICD-10 updates (or whenever ICD-10 is implemented)
View Transmittal R1388OTN.
OIG releases semi-annual report
On May 27, OIG released a semi-annual report that summarizes the activities of the OIG for the six-month period that ended March 31, 2014.
View the report.
Improper payments for E/M services cost Medicare billions in 2010
On May 29, OIG reported Medicare paid $32.3 billion for E/M services in 2010, representing nearly 30% of Part B payments that year. In 2012, OIG reported that physicians increased their billing of higher level codes, which yield higher payment amounts, for E/M services in all visit types from 2001–10.
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