Health Information Management

The week in Medicare updates

APCs Insider, July 25, 2014

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CMS releases National Coverage Determination for single and dual chamber permanent cardiac pacemakers 
On July 10, CMS released a change request stating that, effective for claims with dates of service on or after August 13, 2013, contractors shall allow payment for nationally covered implanted permanent cardiac pacemakers, single chamber or dual chamber, for the indications outlined in the Medicare National Coverage Determinations Manual, Chapter 1, Part 1, Section 20.8.3. 
Effective date: August 13, 2013
Implementation date: To be determined 
View Transmittal R2986CP
View Transmittal R170NCD
View MLN Matters® article MM8525.
 
Provider Reimbursement Manual updated  
On July 11, CMS issued a transmittal to notify the public of changes to the Provider Reimbursement Manual, including multiple deletions of obsolete items. Payments to hospitals, skilled nursing facilities, and home health agencies on a reasonable cost basis that are subject to cost limits have been replaced by payments based on prospective payment systems (PPS). PPS for hospitals was implemented for cost reporting periods beginning on and after October 1, 1983, for skilled nursing facilities for cost reporting periods beginning on and after July 1, 1998 and for home health agencies for cost reporting periods beginning on and after October 1, 2000. Chapter 25 will be reserved for future use.
Effective date: July 11, 2014 
View Transmittal R463PRM.
 
Beneficiary signature requirements changed for ambulance services 
On July 11, CMS issued two change requests on signature requirements for ambulance services. The first removes the requirement that a representative provide his/her address when signing for ambulance services on behalf of a beneficiary. This applies to the Medicare Claims Processing, Chapter 1, Section 50.1.3, and Chapter 26, Section 10.3, Item 12. It also applies to the Medicare Benefit Policy Manual. The second corrects the timeframe for filing a Medicare claim from 15-27 months to 12 months in the Benefit Policy Manual to conform with the policy information in Pub. 100-04, Medicare Claims Processing Manual, Chapter 10, section 20.1.2. 
Effective date: August 12, 2014
Implementation date: August 12, 2014 
View Transmittal R2984CP.
View Transmittal R190BP.
 
Notice of new interest rate for Medicare overpayments and underpayments posted
On July 11, CMS released a notice stating that Medicare Regulation 42 CFR Section 405.378 provides for the charging and payment of interest on overpayments and underpayments to Medicare providers. The Secretary of Treasury certifies an interest rate quarterly. Treasury utilizes the most comprehensive data available on consumer interest rates to determine the certified rate. Interest is assessed on delinquent debts in order to protect the Medicare Trust Funds. The Recurring Update Notification applies to the Medicare Financial Management Manual, Chapter 3, Section 10. 
Effective date: July 18, 2014
Implementation date: July 18, 2014 
View Transmittal R237FM.
 
OPPS and ASC proposed payment rates released in proposed rule
On July 14, CMS posted a proposed rule in the Federal Register that would revise the OPPS and Ambulatory Surgical Center (ASC) payment system for 2015 to implement applicable statutory requirements and changes. In this proposed rule, proposed changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and ASC payment system are described. In addition, this rule would update and refine the requirements for the Hospital Outpatient Quality Reporting Program and the ASC Quality Reporting Program. Comments are due September 2. 
View the notice in the Federal Register.  
Leave a comment.
 
Implementation of a PPS for Federally Qualified Health Centers
On July 16, CMS released a change request to implement the Federally Qualified Health Centers (FQHCs) PPS. Section 10501(i)(3)(A) of the Affordable Care Act (Pub. L. 111-148 and Pub. L. 111-152) added section 1834(o) of the Social Security Act to establish a new system of payment for the costs of FQHC services under Medicare Part B based on prospectively set rates. The statute requires implementation for FQHCs with cost reporting periods beginning on or after October 1, 2014. 
Effective date: October 1, 2014
Implementation date: October 6, 2014
View Transmittal R1395OTN.
 
Coverage for cardiac rehabilitation programs expands
On July 18, CMS released a change request that is effective for dates of service on and after February 18, 2014, to expand Medicare coverage for cardiac rehabilitation services to beneficiaries with stable, chronic heart failure, defined as patients with left ventricular ejection fraction of 35% or less and New York Heart Association class II to IV symptoms, despite being on optimal heart failure therapy for at least six weeks. 
Effective date: February 18, 2014
Implementation date: August 18, 2014 
View Transmittal R530PI
View Transmittal R2989CP
View Transmittal R191BP
View Transmittal R171NCD.
 
CMS releases October 2014 ASP drug pricing files
On July 18, CMS released a change request regarding the average sales price (ASP) payment methodology, which is based on quarterly data submitted to CMS by manufacturers. CMS will supply contractors with the 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 the Medicare Claims Processing Manual, Chapter 4, section 50. 
Effective date: October 1, 2014
Implementation date: October 6, 2014 
View Transmittal R2990CP
View MLN Matters article MM8836.
 
FDA approves new waived tests 
On July 18, CMS released a change request to inform contractors of new CLIA waived tests approved by the FDA. Since these tests are marketed immediately after approval, CMS must notify contractors of the new tests so that they can accurately process claims. There are 25 newly added waived complexity tests. The initial release of this Recurring Update Notification applies to the Medicare Claims Processing Manual, Chapter 16, section 70.8. 
Effective date: October 1, 2014
Implementation date: October 6, 2014 
View Transmittal R2988CP
View MLN Matters article MM8805.



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