Health Information Management

The week in Medicare updates

APCs Insider, September 19, 2014

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CMS updates influenza vaccine payment allowance 
On September 3, CMS released a recurring update notification regarding payment allowances for seasonal influenza virus vaccines, as updated on an annual basis, effective August 1 of each year. The recurring update applies to the Medicare Claims Processing, Chapter 17, section 20.5.9. 
Effective date: August 1, 2014
Implementation date: No later than November 24, 2014 
View Transmittal R3059CP
View MLN Matters® article MM8890.
CMS updates language for related claims
On September 4, CMS released a change request to allow MACs and Zone Program Integrity Contractors the discretion to deny claims that are "related" and provide approved examples of such situations. Transmittal 534, dated August 8, 2014, is being rescinded and replaced by Transmittal 540 to adhere to CMS inpatient recoding policy standards, which was accomplished by removing the recoding language in section 3.2.3. All other information remains the same. 
Effective date: September 8, 2014
Implementation date: September 8, 2014 
View Transmittal R540PI.
NCD revised for hepatitis C virus screening in adults 
On September 5, CMS released a transmittal effective for services performed on or after June 2, 2014, stating it will cover screening for hepatitis C virus consistent with grade B recommendations by the U.S. Preventive Services Task Force for the prevention or early detection of an illness or disability that is appropriate for individuals entitled to benefits under Medicare Part A or enrolled under Part B. 
CMS then released a second transmittal stating this revision to the Medicare National Coverage Determinations Manual is a national coverage determination (NCD). NCDs are binding on all carriers, fiscal intermediaries, contractors with the federal government that review and/or adjudicate claims, determinations, and/or decisions, quality improvement organizations, qualified independent contractors, the Medicare appeals council, and ALJs (see 42 CFR section 405.1060(a)(4) (2005)). An NCD that expands coverage is also binding on a Medicare Advantage organization. In addition, an ALJ may not review an NCD.
Effective date: June 2, 2014,
Implementation date: January 5, 2015, for non-shared MAC edits and CWF analysis; April 6, 2015, for remaining shared systems edits 
View Transmittal R3063CP
View Transmittal R174NCD.
Examining the difference between an NPI and PTAN
On September 5, CMS posted a special edition MLN Matters article explaining the difference between a National Provider Identifier (NPI) and a Provider Transaction Access Number (PTAN). There are no policy changes in this article. 
View MLN Matters article SE1216.
2014-15 influenza resources for healthcare professionals updated 
On September 9, CMS released a special edition MLN Matters article reminding healthcare professionals that Medicare Part B reimburses providers for flu vaccines and their administration. Medicare provides coverage of the flu vaccine without any out-of-pocket costs to the Medicare patient. No deductible or copayment/coinsurance applies. 
View special edition MLN Matters article SE1431.
CMS updates offer to hospitals to withdraw pending appeals for partial payment 
On September 9, CMS released updates regarding its offer for certain hospitals to withdraw pending appeals in exchange for timely partial payments. People can now listen to a recorded teleconference on this topic, and review an updated FAQ document and eligible claim spreadsheet. 
View the updates
Access the recording and FAQ.
CMS releases October update to the 2014 MPFSDB 
On September 10, CMS released a change request amending the payment files issued to contractors based upon the 2014 Medicare Physician Fee Schedule (MPFS) final rule. This Recurring Update Notification applies to the Medicare Claims Processing Manual, Chapter 23, section 30.1. Transmittal 3046, dated August 22, 2014, is being rescinded and replaced by Transmittal 3064.
Effective date: October 1, 2014,
Implementation date: October 6, 2014 
View Transmittal R3064CP
View MLN Matters article MM8888.

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