Health Information Management

The week in Medicare updates

APCs Insider, February 13, 2015

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HCPCS codes subject to and excluded from CLIA edits 
On January 30, CMS released a change request to inform contractors about the new HCPCS codes for 2015 that are subject to and excluded from Clinical Laboratory Improvement Amendments (CLIA) edits. This recurring update notification applies to the Medicare Claims Processing Manual, Chapter 16, section 70.9. 
Effective date: January 1, 2015
Implementation date: April 6, 2015 
View Transmittal R3182CP
View MLN Matters article MM9035.
 
CMS implements new condition code 53 effective July 1
On January 30, CMS released a change request implementing condition code 53 (initial placement of a medical device provided as part of a clinical trial or a free sample) for reporting on the outpatient hospital claim. 
Effective date: July 1, 2015 for claims received on or after
Implementation date: July 6, 2015
View Transmittal R3181CP
View MLN Matters article MM8961.
 
CMS releases April 2015 Part B drug pricing files and revisions to prior quarterly pricing files 
On January 30, CMS released its quarterly update to the average sales price (ASP) files. The ASP methodology is based on quarterly data submitted to CMS by manufacturers. CMS supplies contractors with the ASP and not otherwise classified drug pricing files for Medicare Part B drugs on a quarterly basis. Payment allowance limits under the OPPS are incorporated into the OCE through separate instructions that can be located in Chapter 4, section 50 of the Internet-Only Manual.
Effective date: April 1, 2015
Implementation date: April 6, 2015 
View Transmittal R3180CP
View MLN Matters article MM9084.
 
CMS posts technology assessment related to cognitive outcomes after cardiovascular procedures
On February 2, CMS posted a new technology assessment related to cognitive outcomes after cardiovascular procedures in older adults. 
View the technology assessment.
 
OIG posts Medicare Compliance Review of Iowa Methodist Medical Center for 2010 and 2011 
On February 3, OIG posted a report detailing its Medicare Compliance Review of Iowa Methodist Medical Center. 
View the report.
 
CMS updates transmittal for timeline of complex MAC reviews
On February 4, CMS released a change request to change the number of days MACs have to conduct complex review from 60 days to 30 days. Transmittal 566, dated January 23, 2015, is being rescinded and replaced by Transmittal 568 to correct the transmittal number, which was inadvertently duplicated for CR 8443. Additionally, information from CR 8802, section 3.2.3 that was erroneously overwritten has been included. All other information remains the same.
 
Effective date: March 1, 2015
Implementation date: March 1, 2015 
View Transmittal R568PI.
 
CMS addresses timeframe for response to Additional Documentation Requests 
On February 4, CMS released a change request to update section 3.2.3.2 of Chapter 3 of the Program Integrity Manual to address the new prepayment review timeframe for Additional Documentation Requests (ADRs) submission and to instruct the Shared Systems Maintainers to produce ADRs to reflect the change. Transmittal 566 for CR 8583, issued January 7, 2015, is being rescinded and replaced by Transmittal 567, to correct the transmittal number that was erroneously duplicated. All other information remains the same.
Effective date: April 1, 2015
Implementation date: April 6, 2015
View Transmittal R567PI.
 
Medicare to cover screening for lung cancer for certain patients
On February 5, CMS posted decision memorandum and a press release regarding a National Coverage Determination (NCD) for screening for lung cancer with low-dose computed tomography (LDCT). The coverage is effective immediately. Medicare will now cover lung cancer screening with LDCT once per year for Medicare beneficiaries who meet certain criteria.
View the decision memorandum.
View the press release.
 
OIG posts Medicare Compliance Review of University of North Carolina Hospitals for the January 2011 through September 2012
On February 6, OIG posted a report detailing a Medicare Compliance Review of University of North Carolina Hospitals. This hospital complied with Medicare billing requirements for 192 of the 251 inpatient and outpatient claims reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 59 claims, resulting in net overpayments. 
View the report.
 
OIG posts review of Beth Israel Deaconess Medical Center claims that included medical device replacements
On February 5, OIG posted a report Beth Israel Deaconess Medical Center (BIDMC) complied with Medicare billing requirements for 3 of the 23 inpatient and outpatient claims reviewed. However, BIDMC did not fully comply with Medicare billing requirements for the remaining 20 claims, resulting in overpayments of approximately $483,000 for calendar years 2010 through 2013. 
View the report.
 
OIG posts Medicare Compliance Review of Utah Valley Regional Medical Center for 2010 and 2011
On February 5, OIG posted a report detailing a Medicare Compliance Review of Utah Valley Regional Medical Center. Utah Valley Regional Medical Center complied with Medicare billing requirements for 183 of the 232 inpatient and outpatient claims reviewed. However, it did not fully comply with Medicare billing requirements for the remaining 49 claims, resulting in overpayments. 
View the report.
 
OIG posts Medicare Compliance Review of Missouri Baptist Medical Center for 2011 and 2012
On February 5, OIG posted a report detailing a Medicare Compliance Review of Missouri Baptist Medical Center. This hospital complied with Medicare billing requirements for 207 of the 253 inpatient and outpatient claims reviewed. However, it did not fully comply with Medicare billing requirements for the remaining 46 claims, resulting in overpayments.
View the report.



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