Health Information Management

The week in Medicare updates

HIM-HIPAA Insider, January 12, 2015

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Solicitation of new safe harbors and special fraud alerts

On December 30, HHS posted an annual notice in the Federal Register soliciting proposals and recommendations for developing new and modifying existing safe harbor provisions under the federal anti-kickback statute (section 1128B(b) of the Social Security Act), as well as developing new OIG Special Fraud Alerts. Comments are due by March 2, 2015.
 
View the notice in the Federal Register.
Leave a comment.
 
FFS ED Notice updates
On December 30, CMS posted updated new Notice of Medicare Non-Coverage (NOMNC) and Detailed Explanation of Non-Coverage (DENC) form instructions available for download. Neither the NOMNC nor the DENC form has changed, and providers may continue using the current forms.
 
View the documents.
 
CMS announces changes to Recovery Audit Program
On December 31, CMS announced a number of changes to the Recovery Audit Program in response to industry feedback. CMS states that these changes will result in a more effective and efficient program, by enhanced oversight, reduced provider burden, and more program transparency. These changes will be effective with each new contract award beginning with the DME, Home Health, and Hospice Recovery Audit contract awarded December 19, 2014.
 
View the document.
 
Modifications to Medicare Part B Coverage of Pneumococcal Vaccinations
On December 31, CMS released two transmittals to inform contractors it is updating the Medicare coverage requirements to align with the updated Advisory Committee on Immunization Practices recommendations for Coverage of Pneumococcal Vaccinations.
 
Effective date: September 19, 2014
Implementation date: February 2, 2015
 
View Transmittal R202BP.
View Transmittal R3159CP.
 
Evaluation criteria and standards for Beneficiary and Family Centered Care Quality Improvement Organization contract
On December 31, CMS posted a final notice in the Federal Register announcing the general criteria it will use to evaluate the effectiveness and efficiency of Beneficiary and Family Centered Care (BFCC) QIOs that entered into contracts with CMS under the 11th SOW in May 2014. The activities for the BFCC–QIO SOW began August 1, 2014. (This contract allows for a transition period from the incumbent QIOs to the successor QIOs.) This notice also addresses comments made in response to a July 2014 notice regarding these contracts. This final notice is effective from August 1, 2014 to July 31, 2019.
 
View the notice in the Federal Register.
 
Evaluation criteria and standards for Quality Improvement Networks Quality Improvement Program Contracts; Base and Task orders
On December 31, CMS posted a final notice in the Federal Register announcing the general criteria it will use to evaluate the effectiveness and efficiency of Quality Innovation Network (QIN) QIOs that entered into contracts with CMS under the 11th SOW in July 2014. (The activities for the QIN–QIO SOW began August 1, 2014). This notice also addresses comments made in response to an August 2014 notice regarding these contracts. This final notice is effective from August 1, 2014 to July 31, 2019.
 
View the notice in the Federal Register.
 
Corrections to “Revisions to Payment Policies Under the Physician Fee Schedule, Clinical Laboratory Fee Schedule, Access to Identifiable Data for the Center for Medicare and Medicaid Innovation Models and Other Revisions to Part B for CY 2015”
On December 31, CMS posted a document in the Federal Register to correct technical errors that appeared in the final rule with comment period published in the Federal Register November 13, 2014, entitled ‘‘Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule, Clinical Laboratory Fee Schedule, Access to Identifiable Data for the Center for Medicare and Medicaid Innovation Models & Other Revisions to Part B for CY 2015.’’ This document is effect January 1, 2015.
 
View the notice in the Federal Register.



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