Health Information Management

The week in Medicare updates

HIM-HIPAA Insider, December 1, 2014

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2015 annual update to the therapy code list released

On November 14, CMS released a change request updating the list of codes that sometimes or always describe therapy services. The additions, changes, and deletions to the therapy code list reflect those made in the CY 2014 and 2015 HCPCS.
 
Effective date: January 1, 2015
Implementation date: January 5, 2015
 
View Transmittal R3121CP.
View MLN Matters article MM8985.
 
Outpatient therapy cap values for CY 2015 released
On November 14, CMS released a change request to describe the amounts and the policy for outpatient therapy caps for CY 2015. Information related to this recurring update notification can be found in Pub 100-04, Medicare Claims Processing Manual, Chapter 5, Section 10.2.
 
Effective date: January 1, 2015
Implementation date: January 5, 2015
 
View Transmittal R3120CP.
View MLN Matters article MM8970.
 
Rural health clinic (RHC) location determination guidance updated
CMS regional office (RO) survey and certification staff are responsible for making RHC applicant eligibility determinations related to the RHC rural location and shortage area criteria. Although state survey agencies (SA) make preliminary assessments of eligibility when planning their survey schedule, the authority to make a determination may not be delegated to the SA or other non-CMS entities. This memorandum provides instructions on using HRSA’s data warehouse with respect to shortage areas, including when it is necessary to contact HRSA for additional information. The RO may not make a determination whether an initial applicant meets the rural and shortage area eligibility criteria before it receives a recommendation for enrollment approval by the MAC, based on the MAC’s review of the applicant’s completed Form CMS-855A. The clinic must already be open and operating before the RO may make a determination.
 
View the survey and certification letter.
 
Screening for hepatitis C virus (HCV) in adults
On November 19, CMS released a change request rescinding and replacing Transmittal 3063, dated September 5, 2014, regarding coverage of screening for HCV, with Transmittal 3127. Among other changes, RHCs and federally qualified health centers and independent laboratories were added as billing entities and instructions were giving to contractors for processing claims prior to January 1, 2015.
 
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 R3127CP.
View Transmittal R177NCD.
View the revised MLN Matters article MM8871.
 
Update to Medicare deductible, coinsurance and premium rates for 2015
On November 21, CMS released a recurring change request providing instruction for Medicare contractors to update the claims processing system with the new CY 2015 Medicare rates.
 
Effective date: January 1, 2015
Implementation date: January 5, 2015
 
View Transmittal R89GI.
 
Prior authorization of non-emergent hyperbaric oxygen (HBO) therapy
On November 21, CMS posted a notice in the Federal Register announcing a three year Medicare prior authorization model for non-emergent hyperbaric oxygen therapy services in Illinois, Michigan, and New Jersey where there have been high incidences of improper payments for these services. The model will begin on March 1, 2015, in these states.
 
View the notice in the Federal Register.
 
Town Hall meeting on FY 2016 applications for new medical services and technology add-on payments
On November 21, CMS posted a notice in the Federal Register announcing a Town Hall meeting to discuss FY 2016 applications for add-on payments for new medical services and technologies under the hospital IPPS. Interested parties are invited to this meeting to present their comments, recommendations, and data regarding whether the FY 2016 new medical services and technologies applications meet the substantial clinical improvement criterion. The Town Hall
Meeting will be held at 9 a.m. (Eastern) Tuesday, February 3, 2015.
 
View the notice in the Federal Register.
Leave a comment.
More information and registration.
 
Continued approval of DNV GL-Healthcare (DNV GL) critical access hospital (CAH) accreditation program
On November 21, CMS posted a final notice in the Federal Register announcing its decision to approve DNV GL 1 for continued recognition as a national accrediting organization for CAHs wishing to participate in the Medicare or Medicaid programs. This final notice is effective December 23, 2014, through December 23, 2020.
 
View the notice in the Federal Register.
 
MLN Connects™ National Provider Call-Certifying Patients for the Medicare Home Health Benefit
CMS is holding a National Provider Call to provide an overview of certifying patient eligibility for the Medicare home health benefit. It includes an overview of a new requirement for HHAs to obtain documentation from the certifying physician and/or the acute/post-acute care facility's medical record for the patient that served as the basis for the certification of patient eligibility. This new requirement was finalized in the CY 2015 Home Health PPS final rule (CMS-1611-F) effective for home health episodes beginning on or after January 1, 2015.
 
View the story.
More information and registration.
 
Guidance for the public, industry, and CMS staff: coverage with evidence development
On November 21, CMS posted guidance that describes the history of coverage with evidence development and its statutory basis, and reflects public comments received on a draft guidance document published on November 12, 2012.  
 
View the guidance.



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