Health Information Management

The week in Medicare updates

HIM-HIPAA Insider, June 1, 2015

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July 2015 quarterly Average Sales Price (ASP) Medicare Part B drug pricing files and revisions
On May 15, CMS released a change request updating the ASP methodology, which is based on quarterly data submitted to CMS by manufacturers. CMS will supply 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, Medicare Claims Processing Manual, section 50 of the Internet Only Manual.

Effective date: July 1, 2015
Implementation date: July 6, 2015

View Transmittal R3258CP.
View MLN Matters article MM9159.

July 2015 quarterly update to the Medicare Physician Fee Schedule Database
On May 15, CMS released a change request amending payments to payment files issued to contractors based upon the CY 2015 Medicare Physician Fee Schedule final rule. This recurring update notification applies to Pub. 100-04, Medicare Claims Processing Manual, Chapter 23, section 30.1.

Effective date: January 1, 2015 for dates of service on or after January 1, 2015, unless otherwise stated
Implementation date: July 6, 2015

View Transmittal R3259CP.
View MLN Matters article MM9152.

Release of the Individualized Quality Control Plan (IQCP) workbook
On May 15, CMS posted a survey and certification letter for the release of Clinical Laboratory Improvement Amendment Workbook, co-authored with Centers for Disease Control and Prevention: IQCP, Individualized Quality Control Plan, Developing an IQCP, A Step-by-Step Guide.

View the survey and certification letter.

First Coast Service Options, Inc., paid some unallowable sleep study claims
On May 20, the OIG posted a report regarding its audit of First Coast Service Options, Inc., the Medicare administrative contractor for Jurisdiction 9. First Coast made some payments to providers for sleep study services that were not in accordance with Medicare reimbursement requirements. Of the 100 sampled beneficiaries, First Coast made payments to providers for sleep study services that did not meet Medicare billing requirements for 61 beneficiaries with 160 corresponding lines of service, resulting in overpayments totaling $68,000.

View the report.

Revised hospital radiologic and nuclear medicine services interpretive guidelines—State Operations Manual Appendix A
On May 15, CMS posted a certification letter for updated interpretive guidelines for the hospital CoPs for the below to reflect current accepted standards of practice: Radiologic Services at 42 CFR 482.26, and Nuclear Medicine Services at 42 CFR 482.53.

View the survey and certification letter.

Revisions to deeming authority and enforcement procedures, including definition of immediate jeopardy
On May 22, CMS posted a final rule in the Federal Register revising the survey, certification, and enforcement procedures related to CMS oversight of national accrediting organizations (AOs). The revisions implement certain provisions under the Medicare Improvements for Patients and Providers Act of 2008. The revisions also clarify and strengthen our oversight of AOs that apply for, and are granted, recognition and approval of an accreditation program in accordance with the statute. The rule also extends some provisions, which are applicable to Medicare-participating providers, to Medicare-participating suppliers subject to certification requirements, and clarifies the definition of immediate jeopardy. This final rule is effective on July 21, 2015.

View the notice in the Federal Register.

Announcement of August 2015 Advisory Panel on Hospital Outpatient Payment
On May 22, CMS posted a notice in the Federal Register announcing the summer meeting of the Advisory Panel on Hospital Outpatient Payment for 2015. The purpose of the panel is to advise the Secretary of the HHS and the Administrator of CMS on the clinical integrity of the APC groups and their associated weights and hospital outpatient therapeutic services supervision issues. The meeting will take place on Monday, August 24, and Tuesday, August 25, from approximately 9 a.m. Eastern to approximately 5 p.m. Eastern each day. Registration for the meeting will begin Monday, June 29 and end Friday, July 31.

View the notice in the Federal Register.

CGS Administrators, LLC, overpaid providers that incorrectly billed for aflibercept
On May 22, the OIG posted a report stating CGS Administrators, LLC, overpaid providers that incorrectly billed for aflibercept by $1.8 million. CGS made the overpayments because it relied on the providers to confirm that the line items were billed correctly.

View the report.



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