Health Information Management

The week in Medicare updates

APCs Insider, December 12, 2014

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CMS updates Program Integrity Manual
On November 26, CMS released a change request to update Chapter 3, Section 3.2.3.4 of the Program Integrity Manual (PIM). The changes address Additional Documentation Request (ADR) reporting requirements for MAC, Recovery Auditors, Comprehensive Error Rate Testing, and Supplemental Medical Review Contractor. The templates are provided to show the elements, formatting, and order contractors shall use when constructing postpayment ADR letters. Contractors shall maintain the format of the letter, but have the discretion to insert case-specific information. 
CMS also released a separate change request to add certain provider enrollment policy clarifications to Chapter 15 of the PIM
Effective date: December 29, 2014
Implementation date: December 29, 2014 
View Transmittal R557PI.
View Transmittal R556PI.
View MLN Matters article MM8810.
 
 
CMS issues quarterly update for durable medical equipment bidding 
On November 26, CMS released a change request to update the durable medical equipment  Competitive Bidding Program files, which is done on a quarterly basis in order to implement necessary changes to the HCPCS, ZIP code, single payment amount, and supplier files. These requirements provide specific instruction for implementing the files. The Recurring Update Notification applies to the Medicare Claims Processing Manual, Chapter 23, Section 100. 
Effective date: April 1, 2015
Implementation date: April 6, 2015 
View Transmittal R3136CP
View MLN Matters article MM8918.
 
CMS releases update to the CCI Edits, Version 21.1 
On November 26, CMS released the normal update to the CCI procedure-to-procedure edits. The Recurring Update Notification applies to Medicare Claims Processing Manual, Chapter 23, Section 20.9. 
Effective date: April 1, 2015
Implementation date: April 6, 2015 
View Transmittal R3132CP
View MLN Matters article MM8908.
CMS releases new proposal to improve Accountable Care Organizations 
On December 1, CMS released a proposal to strengthen the Shared Savings Program for Accountable Care Organizations (ACOs) through a greater emphasis on primary care services and promoting transitions to performance-based risk arrangements. The proposed rule reflects input from program participants, experts, consumer groups, and the stakeholder community at large. CMS is seeking to continue this dialogue to ensure that the Medicare Shared Savings Program ACOs are successful in providing seniors and people with disabilities with better care at lower costs.  
View the press release.
 
CMS proposes changes to Medicare Shared Savings Program regulations 
On December 2, CMS issued a proposed rule to update and improve policies governing the Medicare Shared Savings Program. The proposed rule addresses proposed changes to several program areas including beneficiary assignment, data sharing, available risk models, eligibility requirements, participation agreement renewals, and compliance and monitoring. Additionally, CMS seeks comment on issues related to financial benchmarking and waivers for program and other payment rules. Changes to the Shared Savings Program quality reporting requirements were finalized in the 2015 Medicare Physician Fee Schedule October 31. 
View the fact sheet.
 
CMS updates enforcement requirements deadline for Part D drug prescribers
On December 3, CMS released a Special Edition MLN Matters article regarding its announcement that it will delay enforcement of the requirements in 42 CFR 423.120(c)(6) until December 1, 2015. Nevertheless, prescribers of Part D drugs must submit their Medicare enrollment applications or opt-out affidavits to their Part B MACs by June 1, 2015, or earlier, to ensure that MACs have sufficient time to process the applications or opt out affidavits and avoid their patients’ prescription drug claims from being denied by their Part D plans, beginning December 1, 2015. 
View MLN Matters Special Edition article SE1434.
 
CMS finalizes new safeguards to reduce Medicare fraud 
On December 3, CMS issued a final rule that will improve its ability to deny or revoke the enrollment of entities and individuals that pose a program integrity risk to Medicare. The fact sheet summarizes CMS’ regulatory additions and changes, including expanded ability to deny enrollment based on certain criteria. 
View the fact sheet.
View the press release.
 
CMS finalizes requirements for Medicare Incentive Reward Program and Provider Enrollment 
On December 5, CMS posted a final rule in the Federal Register implementing various provider enrollment requirements. These regulations will be effective February 3, 2015. 
View the notice in the Federal Register.
 
CMS releases provider enrollment application fee amount for 2015 
On December 5, CMS posted a notice in the Federal Register announcing a 2015 application fee of $553 for institutional providers initially enrolling in the Medicare or Medicaid program or the Children’s Health Insurance Program; revalidating their Medicare, Medicaid, or CHIP enrollment; or adding a new Medicare practice location. This fee is required with any enrollment application submitted on or after January 1, 2015m and on or before December 31, 2015. This notice is effective January 1, 2015. 
View the notice in the Federal Register.



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