The week in Medicare updates
APCs Insider, October 10, 2014
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CMS updates Medicare Claims Processing Manual to provide language-only changes for conversion to ICD-10
On September 26, CMS released a change request containing language-only changes for updating ICD-10 language in the Medicare Claims Processing Manual. There are no new coverage policies, payment policies, or codes introduced in this transmittal. Transmittal 3020, dated August 8, is being rescinded and replaced by Transmittal 3081, dated September 26, to delete the general rules for reporting diagnoses on claims in section 10.1. Providers have questioned if these bullets were providing different information than the ICD-9-CM Official Guidelines for Coding and Reporting and ICD-10-CM Official Guidelines for Coding and Reporting. This interpretation was not intended. Providers must refer to the official ICD-9-CM and ICD-10-CM guidelines, which are a HIPAA standard, for these instructions. The location of the guidelines is shown in this section. All other information remains the same.
Effective date: Upon implementation of ICD-10
Implementation date: Upon implementation of ICD-10
View Transmittal R3081CP.
CMS issues October 2014 OPPS update
On September 26, CMS released a change request describing changes to and billing instructions for various payment policies implemented in the October 2014 OPPS update. The October 2014 Integrated Outpatient Code Editor (I/OCE) and OPPS Pricer will reflect HCPCS, APC, HCPCS Modifier, and Revenue Code additions, changes, and deletions identified in this change request. Transmittal 3012, dated August 1, is being rescinded and replaced by Transmittal 3080, dated September 26, to correct the long descriptor for HCPCS code C9135 (see this week's Q&A for more details).
Effective date: October 1, 2014
Implementation date: October 6, 2014
View Transmittal R3080CP.
CMS releases change request to update auditing processes
On September 26, CMS released a change request pertaining to the national Recovery Audit Program. Transmittal 226, dated September 6, 2013, is being rescinded and replaced by Transmittal 241, dated September 26, 2014, to reflect up-to-date MAC processes. All other information remains the same.
Effective date: October 7, 2013
Implementation date: October 7, 2013
View Transmittal R241FM.
CMS updates hospital appeals settlement offer FAQs
On October 1, CMS updated its website to allow review of an updated Frequently Asked Question document.
Access the Frequently Asked Questions.
CMS revises the State Operations Manual
On October 3, CMS released a change request to reflect current policies concerning hospitals enrolled in Medicaid, but not the Medicare program; providers and suppliers deemed to satisfy participation requirements on the basis of their accreditation by a CMS-approved Medicare accreditation program; determination of the effective date of the Medicare agreement/supplier approval; and to clarify the type of subsequent survey required when an initial applicant for participation in Medicare has been denied initial certification based on an initial survey findings.
Effective date: October 3, 2014
Implementation date: October 3, 2014
View Transmittal R123SOMA.
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