Health Information Management

The week in Medicare updates

HIM-HIPAA Insider, July 7, 2014

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CMS updates Chapter 3 of the Program Integrity Manual (PIM)

 
On June 20, CMS released a change request to update a section of Chapter 3 of the PIM. The changes address reimbursing providers and health information handlers for additional documentation.
 
Effective date: July 22, 2014
Implementation date: July 22, 2014
 
View Transmittal R523PI.
 
CMS clarifies billing instructions related to the home health benefit
 
On June 20, CMS released a change that updates Pub. 100-04, Medicare Claims Processing Manual, to specify the physician specialty codes that are excluded from home health consolidated billing. It also will make conforming changes related to the retirement of the home health advance beneficiary notice, and make miscellaneous changes to conform term and code usage to national standards.
 
Effective date: September 23, 2014 (ICD-10: Upon Implementation of ICD-10)
Implementation date: September 23, 2014 (ICD-10: Upon Implementation of ICD-10)
 
View Transmittal R2977CP.
 
View MLN Matters article MM8775.
 
CMS receives application for critical access hospital (CAH) accreditation program
 
On June 27, CMS posted an acknowledgement in the Federal Register that it received an application from Det Norske Veritas Healthcare. This organization is applying for continued recognition as a national accrediting organization for CAH facilities that wish to participate in the Medicare or Medicaid programs.
 
View the notice in the Federal Register.
 
Leave a comment.
 
CMS accepting comments The Joint Commission’s (TJC) ambulatory surgical accreditation
 
On June 27, CMS posted a proposed notice in the Federal Register that acknowledges the receipt of an application from TJC for continued recognition as a national accrediting organization for ambulatory surgical centers that wish to participate in the Medicare or Medicaid programs. Comments are due by July 28.
 
View the notice in the Federal Register.
 
Leave a comment.
 
TJC hospital accreditation program for hospitals approved
 
On June 27, CMS posted a final notice in the Federal Register announcing their decision to approve TJC for continued recognition as a national accrediting organization for hospitals that want to participate in the Medicare or Medicaid programs. A hospital that participates in Medicaid must also meet the Medicare conditions of participation. This approval is effective July 15, 2014, through July 15, 2020.
 
View the notice in the Federal Register.
 
OIG issues special fraud alert: Laboratory payments to referring physicians
 
On June 25, OIG posted a special fraud alert to its website that addresses compensation paid by laboratories to referring physicians and physician group practices for blood specimen collection, processing, and packaging, as well as for submitting patient data to a registry or database.
 
View the report.
 
 “Medicare Program Integrity: Screening Out Errors, Fraud, and Abuse” hearing update
 
On June 25, OIG posted the testimony of Gary Cantrell, deputy inspector general for investigations at OIG, regarding OIG's efforts to improve Medicare oversight and reduce waste, fraud, and abuse. He stated fighting waste, fraud, and abuse in Medicare and other programs is a top priority. 
 
View the testimony.



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