The week in Medicare updates
APCs Insider, February 20, 2015
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CMS updates implementation date for laboratory travel allowance fee
On February 5, CMS rescinded and replaced a transmittal released in January on the laboratory travel allowance to update the implementation date.
Effective date: January 1, 2015
Implementation date: As soon as possible, but no later than April 24, 2015
View Transmittal R3189CP.
CMS provides Recovery Auditor-specific “no documentation” medical necessity denial reason code
On February 6, CMS released a change request to provide a Recovery Auditor specific "no documentation" reason code for MACs to append to prepayment claim denials.
Effective date: July 1, 2015
Implementation date: July 6, 2015, for define/analyze and design application; October 5, 2015, for hours for code development/test and alpha testing
View Transmittal R1462OTN.
CMS releases fact sheet on new specialty care model
On February 12, CMS posted a fact sheet regarding its development of new payment and service delivery models that will improve quality and reduce the cost of specialty care. The Oncology Care Model (OCM) is the second specialty care model to be announced. OCM is an innovative multi-payer model in which practices enter into payment arrangements that include financial and performance accountability for episodes of care surrounding chemotherapy administration to cancer patients. This model aims to provide higher quality, more highly coordinated oncology care at a lower cost. OCM is a five-year model and will begin in spring 2016.
OIG releases advisory opinion regarding the effect of exclusion from Medicare and Medicaid
On February 13, the Office of Inspector General (OIG) posted Advisory Opinion 15-02 about exclusion from federal healthcare programs.
View the report.
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