Health Information Management

The week in Medicare updates

APCs Insider, January 30, 2015

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Medicare Shared Systems modified to capture various HIPAA-compliant fields 
On January 14, CMS released a change request regarding the need to expand the claim field record used for processing claims information located on the UB-04, or 837I transaction appearing on the claim form. Transmittal 3107, dated November 6, 2014, is being rescinded and replaced by Transmittal 3164 to remove bill types 81x and 82x from Business Requirement 8384.2.4. All other information remains the same. 
Effective date: April 1, 2015
Implementation date: April 6, 2015
View Transmittal R3164CP.
View MLN Matters article MM8384.
 
CMS issues emergency update to the 2015 Medicare Physician Fee Schedule Database
On January 16, CMS released a change request stating it issued payment files to contractors based on the CY 2015 Medicare Physician Fee Schedule final rule. This change request amends those payment files, including an updated conversion factor of $35.7547 for services furnished between January 1, 2015, and March 31, 2015, consistent with the Protecting Access to Medicare Act of 2014 that provides for a zero percent update from 2014 rates. Note that Medicare contractors have already done the work related to this change request via a previous direction, which was implemented on January 5, 2015. Therefore, the implementation date is prior to the release date of this change request.
Effective date: January 1, 2015
Implementation date: January 5, 2015
View Transmittal R3166CP.
View MLN Matters article MM9081.
 
CMS updates Medicare Managed Care, Chapter 4
On January 16, CMS released a change request stating Medicare Managed Care, Chapter 4, has been revised with new content and clarification of policy in several areas. Additionally, the chapter has undergone a reorganization of sections to provide greater clarity.
Effective date: January 1, 2015
Implementation date: January 1, 2015
 
View Transmittal R120MCM.
 
CMS updates ICD-10 limited end-to-end testing information  
On January 20, CMS released a change request will allow for MACs to test with a limited number of providers and clearinghouses to ensure claims with ICD-10 codes can be processed from submission to remittance. This additional testing effort will further ensure a successful transition to ICD-10. Transmittal 1426, dated September 12, 2014, is being rescinded and replaced by Transmittal 1451 to incorporate technical direction since the change request’s original issuance, add three Excel® spreadsheet attachments, update deliverable dates, and include touch base calls during the testing weeks. Additionally, this change request is no longer sensitive/controversial and may be posted to the Internet. All other information remains the same. 
Effective date: September 12, 2014, for MACs and CEDI (non-systems change requirements) (Note: This is the due date of the first MAC and CEDI requirement); January 26, 2015, for FISS and CEDI coding for January Testing Week; April 27, 2015, for FISS and CEDI coding for April Testing Week; July 20, 2015, for FISS and CEDI coding for July Testing Week
Implementation date: January 5, 2015, for FISS and CEDI coding for January Testing Week; February 16, 2015, for MAC requirements for the January 15 testing. This is the due date of the last MAC deliverable; April 6, 2015, for FISS and CEDI coding for April Testing Week; May 18, 2015, for MAC requirements for the April 15 testing. This is the due date of the last MAC deliverable; July 6, 2015, for FISS and CEDI coding for July Testing Week; August 10, 2015, for MAC requirements for the July 15 testing. This is the due date of the last MAC deliverable.
 
View Transmittal R1451OTN
View MLN Matters article MM8867.
 
OIG posts letter to American Hospital Association regarding hospital compliance reviews 
On January 22, OIG posted a letter written by Gloria Jarmon, deputy inspector general for Audit Services for OIG, addressed to the American Hospital Association regarding OIG’s hospital compliance reviews.
View the letter.
 
OIG posts report on Medicare's oversight of compounded pharmaceuticals used in hospitals 
On January 22, OIG posted a report regarding a review OIG completed on CMS and CMS-approved accreditors’ oversight of compounded-sterile preparations of pharmaceuticals used in acute care hospitals. 
View the report.
 
CMS releases article on continued use of modifier -59 
On January 22, CMS released a special edition MLN Matters® article to clarify the use of modifier -59 (distinct procedural service) after January 1, 2015. 
View special edition MLN Matters article SE1503.
 
CMS schedules meeting of Medicare Evidence Development and Coverage Advisory Committee
On January 23, CMS posted a notice in the Federal Register announcing a public meeting of the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) will be held from 7:30 a.m. to 4:30 p.m. (Eastern) Tuesday, March 24, 2015. The Committee generally provides advice and recommendations concerning the adequacy of scientific evidence needed to determine whether certain medical items and services can be covered under the Medicare statute. This meeting will focus on selected molecular pathology tests for the estimation of prognosis in common cancers. This meeting is open to the public in accordance with the Federal Advisory Committee Act (5 U.S.C. App. 2, section 10(a)). Written comments must be received by 5 p.m. (Eastern) Monday, February 23. Once submitted, all comments are final. 
View the notice in the Federal Register
Register for the meeting.



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