Health Information Management

The week in Medicare updates

HIM-HIPAA Insider, October 6, 2014

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To clarify and correct existing instructions
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.
 
Effective date: Cost Reporting Periods ending on or after September 30, 2014
 
View Transmittal R6P241.
 
To clarify and correct the existing instructions and incorporate statutory and regulatory changes
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-2552-10.
 
Effective date: Cost Reporting Periods ending on or after June 30, 2014
 
View Transmittal R6P240.
View Transmittal R6P240f.
View Transmittal R6P240s.
 
Update to the Medicare Payment Rates for routine SNF-type services by swing-bed hospitals during calendar years 2015
On September 19, CMS released a change request to add Table 26 to Section 2231, Regional Medicare Swing-Bed-Rates to update the Medicare Payment Rates for routine skilled nursing facility-type services by swing-bed hospitals during calendar years 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.
 
January 2015 quarterly average sales price (ASP) Medicare Part B drug pricing files and revisions to prior quarterly pricing files
On September 19, CMS released a change request discussing the ASP methodology, which is based on quarterly data submitted to CMS by manufacturers. CMS will supply 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 that can be located in Chapter 4, section 50 of the IOM.
 
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 update Chapter 16 of the Medicare Claims Processing Manual 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. ,.
 
Effective date: December 22, 2014
Implementation date: December 22, 2014
 
View Transmittal R3071CP
View MLN Matters article MM8883.
 
Updated Frequently Asked Questions (FAQs) regarding hospital appeals settlement offer
On September 22, CMS updated the list of FAQs regarding its offer to pay claims on appeal at 68% in exchange for dropping all pending appeals.
 
View the FAQs.
 
New physician specialty code for interventional cardiology
On September 23, CMS released a change request to create a new physician specialty code for interventional cardiology (C3) and a new non-physician specialty code for restricted use (C4). In addition to delete ‘Clinical’ from the description of specialty code 62, delete "Supplier" from the name of specialty code 88 and to change specialty code 95 to Unknown Supplier. Transmittal 3061, dated September 4, 2014, is being rescinded and replaced by Transmittal 3073, dated September 23, 2014, to renumber the provider education requirement. All other information remains the same.
 
Effective date: January 1, 2015
Implementation date: January 5, 2015
 
View Transmittal R3073CP.
 
Correction to hospice notice of revocation processing
On September 24, CMS released a change request to require an update to the Direct Data Entry (DDE) system to allow providers access to all fields necessary to complete a termination or revocation of a hospice election prior to submitting their final claim. Transmittal 1400, dated August 1, 2014, is being rescinded and replaced by Transmittal 1428 to correct the first sentence of the Background section. The reference to three days is changed to five days. All other information remains the same.
 
Effective date: January 1, 2015
Implementation date: January 5, 2015
 
View Transmittal R1428OTN.
 
Date correction to diagnosis code reporting on Religious Nonmedical Health Care Institution (RNHCI) claims
On September 24, CMS released a change request to correct billing instructions for 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.
 
Adjustment to the amount in controversy (AIC) threshold amounts for CY 2015
On September 26, CMS posted a notice in the Federal Register announcing the annual adjustment in the AIC threshold amounts for Administrative Law Judge (ALJ) hearings and judicial review under the Medicare appeals process. The adjustment to the AIC threshold amounts will be effective for requests for ALJ hearings and judicial review filed on or after January 1, 2015. The calendar year 2015 AIC threshold amounts are $150 for ALJ hearings and $1,460 for judicial review. This notice in effective on January 1, 2015.
 
View the notice in the Federal Register.
Leave a comment.
 
OIG Advisory Opinion No. 14-08
On September 24, OIG 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.
 
Clarification: 2013 Quality Resource and Use Reports (QRURS) not yet available, will be shortly
The MLN ConnectsTM Provider eNews and the eHealth list serve messages provided directions to access your 2013 QRUR. To clarify, the 2013 QRURs are not available at this time but will be available shortly. CMS will make the 2013 QRURs available for all physician group practices and solo practitioners nationwide. Please stay tuned for updates to the Physician Feedback/ Value Modifier website for announcements about the availability of the 2013 QRURs.
 
View the clarification on the Physician Center page.
 
Negative pressure wound therapy technologies for chronic wound care in the home setting
A technology assessment was added relevant to negative wound pressure therapy for chronic wound care in the home setting.
 
View the Technology Assessment.



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