Health Information Management

The week in Medicare updates

APCs Insider, August 1, 2014

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Statistical sampling initiative for claims begins
The Office of Medicare Hearings and Appeals (OMHA) was created by the Medicare Modernization Act of 2003 to simplify the appeals process and make it more efficient. It is responsible for Level 3 of the Medicare appeals process. OMHA statistical sampling is a pilot to provide appellants with an option for addressing large volumes of claim disputes at the Administrative Law Judge hearing level of the Medicare claim appeals process.
View details and eligibility.
 
Limitations in manufacturer reporting of Part B drug data detailed
On July 21, the Office of Inspector General posted an article detailing a study that compared data in CMS' background and crosswalk files—the agency's two average sales price (ASP) related files—with two national drug compendia to determine the number of manufacturers that did not report required ASPs in the third quarter of 2012. 
View the report.
 
NCD for cardiac rehabilitation programs for chronic heart failure posted
On July 21, CMS posted an NCD regarding cardiac rehabilitation programs for chronic heart failure patients. Effective for dates of service on and after February 18, 2014, CMS determined that the evidence is sufficient to expand coverage for cardiac rehabilitation services under 42 CFR §410.49(b)(1)(vii) to beneficiaries with stable, chronic heart failure.
View the description.
 
Quarterly listing of program issuances published 
On July 25, a quarterly notice was published in the Federal Register that lists CMS manual instructions, substantive and interpretive regulations, and other Federal Register notices that were published from April through June 2014.
View the notice in the Federal Register.



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