Health Information Management

The week in Medicare updates

HIM-HIPAA Insider, August 4, 2014

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Statistical sampling initiative

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 average sales price (ASP) data for Part B drugs
On July 21, OIG posted an article detailing a study that compared data in CMS' background and crosswalk files-the agency's two 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 (20.10.1)
On July 21, CMS posted a 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, defined as patients with left ventricular ejection fraction of 35% or less and New York Heart Association (NYHA) class II to IV symptoms despite being on optimal heart failure therapy for at least six weeks. Stable patients are defined as patients who have not had recent (< six weeks) or planned (< six months) major cardiovascular hospitalizations or procedures.
 
View the description.
 
Quarterly listing of program issuances—April through June 2014
On July 25, this quarterly notice was published in the Federal Register. It lists CMS manual instructions, substantive and interpretive regulations, and other Federal Register notices that were published from April through June 2014, relating to the Medicare and Medicaid programs and other programs administered by CMS.
 
View the notice in the Federal Register.



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