Health Information Management

The week in Medicare updates

APCs Insider, April 10, 2015

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CMS provides front-end updates for July
On March 26, CMS released a change request to provide the July 2015 Common Edits and Enhancements Module (CEM) edits for Part A and Part B MACs and Common Electronic Data Interchange (CEDI) contractors. Additionally, this change request directs Shared Systems to appropriately update the CEM. Transmittal 1460, dated January 30, 2015, is being rescinded and replaced by Transmittal 1480 to remove edits X223.242.2300.HI01-2.050, X223.258.2300.HI01-2.020, X223.271.2300.HI01-2.020, X223.284.2300.HI01-2.020, and X222.239.2300.HI01-2.030 from the 837I, 837P, and CEDI spreadsheets. All other information remains the same. 
Effective date: July 1, 2015
Implementation date: July 6, 2015 
View Transmittal R1480OTN.
 
CMS removes multiple NCDs using expedited process 
On March 27, CMS released a change request to remove sections 50.6-tinnitus masking, 160.4-stereotactic cingulotomy as a means of psychosurgery, 160.6-carotid sinus nerve stimulator, 160.9-electroencephalographic monitoring during open-heart surgery, 190.4-electron microscope, 220.7-xenon scan, 220.8-nuclear radiology procedure, from the Medicare National Coverage Determinations (NCD) Manual.
Transmittal 180, dated March 6, 2015, is rescinded and replaced by Transmittal 181 to correct Section II on the transmittal page to indicate the manual sections are revised and to correct the section statements in the manual instruction to indicate that each NCD is removed. The section numbers in the NCD manual are being retained for historical purposes. All other information remains the same. 
Effective date: December 18, 2014
Implementation date: April 6, 2015 
View Transmittal R181NCD.
View MLN Matters article MM9095.
 
CMS issues quarterly NCCI edits update
On March 27, CMS released the normal update to the NCCI procedure-to-procedure edits. The recurring update notification applies to the Medicare Claims Processing Manual, Chapter 23, Section 20.9. 
Effective date: July 1, 2015
Implementation date: July 6, 2015 
View Transmittal R3222CP. 
View MLN Matters article MM9108.
  
CMS proposes Stage 3 of EHR Incentive Program
On March 30, CMS posted a Stage 3 proposed rule in the Federal Register that would specify the meaningful use criteria that eligible professionals, eligible hospitals, and critical access hospitals must meet in order to qualify for Medicare and Medicaid EHR incentive payments and avoid downward payment adjustments. The rule would continue to encourage electronic submission of clinical quality measure (CQM) data for all providers where feasible in 2017, propose to require the electronic submission of CQMs where feasible in 2018, and establish requirements to transition the program to a single stage for meaningful use. It would also change the EHR reporting period so all providers would report under a full calendar year timeline with a limited exception under the Medicaid EHR Incentive Program for providers demonstrating meaningful use for the first time. Comments are due by May 29. 
View the notice in the Federal Register. 
Leave a comment.
 
FDA approves first biosimilar product 
On March 30, CMS released an MLN Matters article regarding the first biosimilar product approved by the FDA. CMS policies will ensure Medicare beneficiaries will have access to this new product, as it does for other drugs that receive FDA approval. The purpose of this article is to address questions that have arisen regarding biosimilar products. 
View MLN Matters article SE1509.
 
CMS discontinues coverage of certain prosthetic devices
On March 30, CMS released an MLN Matters article notifying suppliers of changes to the July DMEPOS Fee Schedule related to vacuum erection systems (VES) devices and instructs the DME MACs to implement changes to prohibit payment on claims for VES prosthetic devices (HCPCS codes L7900 and L7902) for dates of service on or after July 1, 2015. 
View MLN Matters article SE1511.
 
Identifying “no documentation” medical necessity denials for claims flagged for Recovery Auditor review 
On March 30, CMS released a change request to provide a Recovery Auditor-specific "no documentation" reason code for MACs to append to prepayment claim denials. Transmittal 1462, dated February 6, 2015, is being rescinded and replaced by Transmittal 1483 to clarify the format of both the electronic report and file format discussed in this change request. All other information remains the same. 
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 R1483OTN.
 
CMS revises State Operations Manual appendices
On April 1, CMS released a change request revising the following appendices to reflect recent regulation changes: Appendix A, Survey Protocol, Regulations and Interpretive Guidelines for Hospitals, Appendix G, Guidance to Surveyors Rural Health Clinics, Appendix L, Guidance for Surveyors Ambulatory Surgical Centers, and Appendix T, Regulations and Interpretive Guidelines for Swing Beds in Hospitals. This change request makes clarifications and updates to existing guidance.
Transmittal 136, dated March 27, 2015, is being rescinded and replaced by Transmittal 137 to correct the regulation number in Appendix T. All other information remains the same. 
Effective date: March 27, 2015
Implementation date: March 27, 2015
View Transmittal R137SOMA.



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