The week in Medicare updates
APCs Insider, March 27, 2015
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CMS releases April 2015 I/OCE specifications
On March 13, CMS released a notification to provide the Integrated OCE instructions and specifications for the Integrated OCE that will be used under the OPPS and non-OPPS for hospital outpatient departments, community mental health centers, all non-OPPS providers, and for limited services when provided in a home health agency not under the Home Health PPS or to a hospice patient for the treatment of a non-terminal illness. The recurring update notification applies to Chapter 4 of the Medicare Claims Processing Manual, section 40.1.
Effective date: April 1, 2015
Implementation date: April 6, 2015
View Transmittal R3218CP.
CMS updates the Hospital and Hospital Health Care Complex Cost Report
On March 13, CMS released several transmittals to clarify and correct the existing instructions and incorporate statutory and regulatory changes to the Hospital and Hospital Health Care Complex Cost Report (Form CMS-2552-10).
Effective date: Cost reporting periods ending on or after October 1, 2014
View Transmittal R7P240.
View Transmittal R7P240f, CMS form 2552-10.
View Transmittal R7P240s, Electronic reporting specifications for Form CMS-2552-10.
CMS releases April 2015 update of the hospital OPPS
On March 13, CMS released a recurring update notification describing changes to and billing instructions for various payment policies implemented in the April 2015 OPPS update. The April 2015 I/OCE and OPPS Pricer will reflect the HCPCS, APC, HCPCS modifier, and revenue code additions, changes, and deletions identified in this change request. This recurring update notification applies to Chapter 4, Medicare Claims Processing Manual, sections 10.12, 20.6.11, and 180.7.
Effective date: April 1, 2015
Implementation date: April 6, 2015
View Transmittal R3217CP.
CMS updates information for reopening claims
On March 16, CMS released a change request implementing National Uniform Billing Committee approved bill type and condition codes for a request for reopening. Transmittal 3203, dated February 20, 2015, is being rescinded and replaced by Transmittal 3219 to change the ":" and "/" in BR8481.12 to a "-". All other information remains the same.
Effective date: October 1, 2014 - Analysis and Design (CWF, FISS and FISS USERS); Reopening Claims received on or after October 1, 2015 - (CWF, FISS and FISS USERS)
Implementation date: October 6, 2014 – Analysis and Design (CWF, FISS and FISS USERS); January 5, 2015, April 6, 2015, and July 6, 2015 (CWF, FISS and FISS USERS) – Coding; October 5, 2015 – Full Implementation (CWF, FISS and FISS USERS)
View Transmittal R3219CP.
Sandoz to pay millions in settlement for misrepresenting drug pricing data to Medicare
On March 16, the Office of Inspector General (OIG) announced Sandoz will pay $12.64 million to settle allegations it misrepresented drug pricing data to the Medicare program. The Sandoz settlement is the largest ever entered into under OIG's drug price reporting authority. Federal law requires drug makers to report both accurate and timely "average sales price" information to CMS. CMS uses this information to set payment amounts for most drugs covered under Medicare Part B.
View the story.
CMS posts tracking sheet for positron emission tomography to identify bone metastasis of cancer
On March 16, CMS posted the National Coverage Analysis for positron emission tomography (NaF-18) to identify bone metastasis of cancer was formally accepted and the review is initiated.
View the NCA tracking sheet.
OIH posts report on compliance review of Northwestern Memorial Hospital for 2011 and 2012
On March 17, OIG posted a report regarding the Medicare Compliance Review of Northwestern Memorial Hospital. This facility complied with Medicare billing requirements for 86 of the 171 inpatient and outpatient claims reviewed. However, the hospital did not fully comply with Medicare billing requirements for the remaining 85 claims, resulting in net overpayments of $272,000 for calendar years 2011 and 2012.
View the report.
OIG posts March compendium
On March 17, the OIG posted the March 2015 Compendium of Unimplemented Recommendations. In this edition, the OIG focuses on the top 25 unimplemented recommendations that, on the basis of OIG’s professional opinion, would most positively impact programs in terms of cost savings and/or quality improvements and should, therefore, be prioritized for implementation. The recommendations come from OIG audits and evaluations, performed pursuant to the Inspector General Act of 1978, as amended.
View the compendium.
National Government Services did not always refer cost reports to Medicare
On March 18, OIG posted a report regarding a review of National Government Services (NGS). The report stated that NGS did not refer seven cost reports (of 18 audited) that should have been referred to CMS for reconciliation.
View the report.
CMS posts NCDs proposed for removal
On March 18, CMS posted the March 2015 list of National Coverage Determinations (NCD) proposed for removal, along with the relevant portion of the Federal Register notice containing the CMS criteria. CMS is soliciting public comment for 30 calendar days on whether any or all of these NCDs should be removed or retained.
View the list and leave a comment.
OIG posts 2014 Health Care Fraud and Abuse Control Program Report
On March 19, OIG posted the FY 2014 Health Care Fraud and Abuse Control Program Report on its website.
View the report.
View the fact sheet regarding the Medicare Fraud Strike Force.
CMS posts revisions to final rule regarding 2015 physician and clinical laboratory fee schedules
On March 20, CMS posted a notice in the Federal Register correcting technical errors in the final rule with comment period published in the November 13, 2014 Federal Register (79 FR 67547–68092) 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.’’ The effective date for the rule was January 1, 2015. This correcting document is effective March 19, 2015. The corrections indicated in this document are applicable beginning January 1, 2015.
View the notice in the Federal Register.
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