Health Information Management

The week in Medicare updates

HIM-HIPAA Insider, June 9, 2014

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OIG acting deputy inspector general testifies about Medicare mismanagement
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 Auditors, and the Medicare appeals process.
 
View the testimony.
 
Provider Reimbursement Manual updated
On May 23, CMS released a transmittal that updated the Provider Reimbursement Manual, Part 2, Chapter 42, Independent Renal Dialysis Facility Cost Report (Form CMS-265-11) 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 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 Chapter 14, Section 10 of the Medicare Claims Processing Manual. As appropriate, this notification also includes updates to the HCPCS.
 
Effective date: July 1, 2014
Implementation date: July 7, 2014
 
View Transmittal R2970CP.
 
View MLN Matters article MM8786.
 
Quarterly update to the NCCI edits released
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.
 
View MLN Matters article MM8662.
 
Quarterly Update for the DME, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program (CBP)
On May 23, CMS updated the DME CBP files, as it does on a quarterly basis 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.
 
View MLN Matters article MM8676.
 
CMS updates Claim Status Category and Claim Status Codes
On May 23, CMS released an update to the Claim Status Category and Claim Status Codes. The Committee has 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.
 
View MLN Matters article MM8684.
 
Instructions available for downloading 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.
 
CMS updates Medicare Claims Processing Manual EDI information
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. In addition, changes are being made to correct material that needs general updating.
 
Effective date: July 25, 2014
Implementation date: July 25, 2014
 
View Transmittal R2965CP.
 
Common Edits and Enhancements Modules (CEM) code set updated
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 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.
 
CMS releases 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 (NCDs). 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.
 
View MLN Matters article MM8691.
 
CMS publishes new to State Operations Manual (SOM) Appendix Y
On May 23, CMS published a new SOM Appendix Y, Organ Procurement Organization (OPO) Interpretive Guidance to provide interpretive guidance to the Regional Offices on the Conditions for Coverage for OPOs Final Rule published May 31, 2006.
 
Effective date: May 23, 2014
Implementation date: May 23, 2014
 
View Transmittal R115SOMA.
 
 
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.
 
Medicare inappropriately paid hospitals' inpatient claims subject to the post-acute care transfer policy
On May 28, OIG released a report stating that Medicare inappropriately paid 6,635 Medicare claims subject to the post-acute care transfer policy from January 2009 through September 2012.
 
View the report.
 
View the podcast.
 
Improper payments for Evaluation and Management (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 2001–2010.
 
View the report.
 
View the podcast.
 
State requirements for conducting background checks on home health agency (HHA) employees
On May 30, OIG released a memorandum presenting the results of two evaluations regarding HHAs’ employment of individuals with criminal convictions.
 
View the memorandum.



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