Health Information Management

The week in Medicare updates

APCs Insider, October 3, 2014

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CMS details changes to reimbursement manual
On September 19, CMS released a change request detailing changes to the Provider Reimbursement Manual, part 2, Provider Cost Reporting Forms and Instructions, Chapter 41, CMS-2540-10 and CMS-2552-10. 
Effective date: Cost reporting periods ending on or after September 30, 2014 
View Transmittal R6P241.
Effective date: Cost reporting periods ending on or after June 30, 2014 
View Transmittal R6P240
View Transmittal R6P240f
View Transmittal R6P240s.
 
CMS updates Medicare payment rates for routine SNF-type services by swing-bed hospitals
On September 19, CMS released a change request to update the Medicare payment rates for routine skilled nursing facility-type services by swing-bed hospitals during calendar year 2015. These rates should be used to carve out swing-bed costs on the hospital cost report. 
Effective date: For services furnished on or after January 1, 2015 
View Transmittal R464PR1
 
CMS releases January 2015 drug pricing files and revisions to prior quarterly pricing files  
On September 19, CMS released a change request discussing the average sales price (ASP) methodology, which is based on quarterly data submitted to CMS by pharmaceutical manufacturers. CMS supplies contractors with the ASP and not otherwise classified 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.
Effective date: January 1, 2015
Implementation date: January 5, 2015 
View Transmittal R3072CP
View MLN Matters® article MM8912.
 
Manual update to clarify claims processing for laboratory services 
On September 19, CMS released a change request to clarify key components of claims processing for laboratory services. These changes are intended only to clarify the existing policies and no system or processing changes are anticipated. The update was made to the Medicare Claims Processing Manual, Chapter 16. 
Effective date: December 22, 2014
Implementation date: December 22, 2014
View Transmittal R3071CP
View MLN Matters article MM8883.
 
CMS issues date correction to diagnosis code reporting on RNHCI claims 
On September 24, CMS released a change request to correct billing instructions for Religious Nonmedical Health Care Institution (RNHCI) claims by removing references to October 1, 2014, as the implementation date of the ICD-10 coding system. Transmittal 3017, issued August 8, 2014, is being rescinded and replaced by Transmittal 3075 to restore language in Chapter 3, section 170.2.2 erroneously overwritten from CR 8679, Transmittal 3030, issued August 22, 2014. All other information remains the same. 
Effective date: November 12, 2014: ICD-10: Upon Implementation of ICD-10
Implementation date: November 12, 2014; ICD-10: Upon Implementation of ICD-10 
View Transmittal R3075CP.
 
CMS adjusts the amount in controversy threshold for 2015  
On September 26, CMS posted a notice in the Federal Register announcing the annual adjustment in the amount in controversy threshold amounts for Administrative Law Judge (ALJ) hearings and judicial review under the Medicare appeals process. The adjustment to the threshold amounts will be effective for requests for ALJ hearings and judicial review filed on or after January 1, 2015. The calendar year 2015 threshold amounts are $150 for ALJ hearings and $1,460 for judicial review. This notice is effective January 1, 2015. 
View the notice in the Federal Register
Leave a comment.
 
Office of Inspector General posts Advisory Opinion No. 14-08
On September 24, the Office of Inspector General posted Advisory Opinion number 14-08. This opinion is regarding the proposed use of a "preferred hospital" network as part of Medicare Supplemental Health Insurance (Medigap) policies. 
View the opinion.



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