Health Information Management

The week in Medicare updates

APCs Insider, March 6, 2015

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AHA posts letter on 2-midnight policy and potential short-stay payment solutions 
On February 13, the American Hospital Association (AHA) posted a letter urging CMS to offer potential payment solutions for hospital stays of less than two midnights in its proposed rule for the FY 2016 IPPS. AHA also asks CMS to extend the partial enforcement delay of the 2-midnight policy until the later of October 1, 2015, or the agency’s implementation date of a short-stay payment policy. 
View the letter.
 
Contractors should develop plans for handling appeals in preparation for ICD-10 implementation 
On February 13, CMS released a change request tasking contractors to evaluate and mitigate the potential impact to the appeals business area due to the implementation of ICD-10. 
Effective date: March 16, 2015
Implementation date: March 16, 2015 
View Transmittal R1469OTN.
 
CMS releases National Coverage Determination for pacemakers 
On February 20, CMS released a change request to inform contractors it issued a National Coverage Determination and concluded that implanted permanent cardiac pacemakers, single chamber or dual chamber, are reasonable and necessary for the treatment of non-reversible symptomatic bradycardia due to sinus node dysfunction and second- and/or third-degree atrioventricular block. 
Effective date: August 13, 2013
Implementation date: July 6, 2015 
View Transmittal R179NCD
View Transmittal R3204CP.
 
Automation of the request for reopening claims process 
On February 20, CMS released a change request implementing National Uniform Billing Committee-approved bill type and condition codes for a request for reopening. Transmittal 3154, dated December 19, 2014, is being rescinded and replaced by Transmittal 3203 to change the effective date to October 1, 2015, and implementation date to October 5, 2015. All other information remains the same.
Effective date: October 1, 2014 for analysis and desgin (CWF, FISS, and FISS USERS); Reopening claims received on or after October 1, 2015 (CWF, FISS, and FISS USERS)
Implementation date: October 6, 2014 for analysis and design (CWF, FISS, and FISS USERS); January 5, 2015, April 6, 2015, and July 6, 2015 (CWF, FISS, and FISS USERS) for coding; October 5, 2015, for full implementation (CWF, FISS and FISS USERS) 
View Transmittal R3203CP.
 
CMS promotes acknowledgement testing with providers 
On February 24, CMS released a change request to instruct MACs to promote three specific acknowledgement testing weeks with providers, and provide data and statistics to CMS to demonstrate readiness for the ICD-10 transition. Transmittal 1423, dated August 22, 2014, is being rescinded and replaced by Transmittal 1472 to update the attached reporting template, remove "provided by CMS" from BR 8858.2, and add BR 8858.6.1 and BR 8858.6.2. All other information remains the same. 
Effective date: 30 days from issuance for provider education, Business Requirement (BR) 2; November 17, 2014, for the November 2014 testing week; March 2, 2015, for the March 2015 testing week; June 1, 2015, for the June 2015 testing week
Implementation date: 30 days from issuance for provider education, Business Requirement (BR) 2; November 17 through 21, 2014, for the November testing week; March 2 through 6, 2015, for the March testing week; June 1 through 5, 2015, for the June testing week; November 26, 2014, for BR 6, for the November 2014 testing week; March 11, 2015, for BR 6, for the March 2015 testing week; June 10, 2015, for BR 6, for the June 2015 testing week 
View Transmittal R1472OTN.
 
CMS issues technical corrections to OPPS and ASC PPS
On February 24, CMS posted a notice to the Federal Register correcting technical errors that appeared in the final rule with comment period published in the Federal Register on November 10, 2014, entitled ‘‘Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Physician-Owned Hospitals: Data Sources for Expansion Exception; Physician Certification of Inpatient Hospital Services; Medicare Advantage Organizations and Part D Sponsors: CMS-Identified Overpayments Associated with Submitted Payment Data.’’ This document is effective February 24, 2015.
View the notice in the Federal Register
View the hospital outpatient website.
 
CMS releases transitioning to ICD-10 fact sheet
On February 25, CMS released a fact sheet regarding the transition to ICD-10. It states CMS is working closely with all industry stakeholders to provide support in transitioning to ICD-10 on October 1, 2015. 
View the fact sheet.
 
HOP Panel meeting agenda set
On February 26, CMS posted documents intended for use at the March 2015 Hospital Outpatient Payment Panel winter meeting. These documents are based on a run of data from 2014 claims through September 2014. These documents are not reflective of the data used for the 2015 OPPS final rule. 
View the website
 
CMS sets dates for HCPCS coding and payment determination meetings
On February 27, CMS posted a notice in the Federal Register announcing the dates, time, and location of the HCPCS public meetings to be held in 2015 to discuss their preliminary coding and payment determinations for all new public requests for revisions to the HCPCS. These meetings provide a forum for interested parties to make oral presentations or to submit written comments in response to preliminary coding and payment determinations. 
View the notice in the Federal Register.



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