The week in Medicare updates
APCs Insider, June 5, 2015
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CMS updates CERT treatment of power mobility devices and ambulance transport claims
On May 22, CMS released a change request to update the Program Integrity Manual Chapter 12 with instructions on how the Comprehensive Error Rate Testing (CERT) program will handle power mobility devices and repetitive schedule non-emergent ambulance transport prior authorization model claims that are selected as part of the CERT sample.
Effective date: June 23, 2015
Implementation date: June 23, 2015
View Transmittal R595PI.
CMS releases July 2015 I/OCE specifications version 16.2
On May 22, CMS released a change request providing the I/OCE instructions and specifications 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 Prospective Payment System or to a hospice patient for the treatment of a non-terminal illness. The Recurring Update Notification applies to the Medicare Claims Processing Manual, Chapter 4, section 40.1.
Effective date: July 1, 2015
Implementation date: July 6, 2015
View Transmittal R3264CP.
CMS updates waived tests
On May 22, CMS released a change request to inform contractors of new laboratory waived tests approved by the FDA. Since these tests are marketed immediately after approval, CMS must notify its contractors of the new tests so that the contractors can accurately process claims. CMS added seven waived complexity tests. This recurring update notification applies to Chapter 16, Medicare Claims Processing Manual, section 70.8 of the Internet-Only Manual, IOM.
Effective date: July 1, 2015
Implementation date: July 6, 2015
View Transmittal R3267CP.
CMS releases change request for microvolt T-wave alternans coverage
On May 22, CMS released two change requests regarding the removal of national non-coverage of the modified moving average (MMA) method, leaving Medicare coverage of microvolt T-wave alternans using MMA and methods of analysis other than spectral analysis for the evaluation of patients at risk for sudden cardiac death from ventricular arrhythmias to be determined by the local MACs. This revision to the Medicare National Coverage Determinations Manual is a national coverage determination.
Effective date: January 13, 2015
Implementation date: June 23, 2015
View Transmittal R3265CP.
View Transmittal R182NCD.
OIG releases mid-year update
On May 28, the Office of Inspector General (OIG) posted its Work Plan Mid-Year Update for Fiscal Year 2015, which summarizes new and ongoing reviews and activities that OIG plans to pursue during the current fiscal year and beyond. This edition removes items that have been completed, postponed, or canceled and includes new items that have been started since October 2014.
View the 2015 Work Plan Mid-Year Update.
CMS releases fact sheet on cardiovascular disease risk reduction model
On May 28, CMS released a fact sheet regarding the Million Hearts® cardiovascular disease (CVD) risk reduction model, which proposes an innovative way of lowering the risks of suffering heart attacks or strokes. The model incentivizes practices to calculate risk for all eligible Medicare beneficiaries by using the American College of Cardiology/American Heart Association Atherosclerotic CVD 10-year pooled cohort risk calculator and to develop risk modification plans based on beneficiary risk profiles.
View the fact sheet.
CMS issues quarterly NCCI edits update
On May 29, CMS released a normal update to the NCCI procedure-to-procedure edits. The attached Recurring Update Notification applies to the Medicare Claims Processing Manual, Chapter 23, Section 20.9.
Effective date: October 1, 2015
Implementation date: October 5, 2015
View Transmittal R3275CP.
View the NCCI website.
CMS releases Instructions for downloading Medicare files for October 2015
On May 29, CMS released a change request to provide instruction for updating the two Medicare ZIP Code files (ZIP5 and ZIP9) for the October 2015 quarter. The recurring update notification applies to Chapter 15, Medicare Claims Processing Manual, section 20.1.5 (B).
Effective date: October 1, 2015
Implementation date: October 5, 2015
View Transmittal R3276CP.
CMS releases Claim Status codes update
On May 29, CMS released a change request to update as needed the Claim Status and Claim Status Category codes used for the Accredited Standards Committee (ASC) X12 276/277 Healthcare Claim Status Request and Response and ASC X12 277 Healthcare Claim Acknowledgment transactions. These code sets are updated at the Code Committee meeting held in conjunction with the ASC X12 meetings three times per year: January/February, June, and September/October. The committee has decided to allow the industry six months for implementation of newly added or changed codes. Contractors are to use the codes that will be posted at www.wpc-edi.com/codes on or about July 1, 2015. This recurring update notification can be found in Chapter 31, Medicare Claims Processing Manual, section 20.7.
Effective date: October 1, 2015
Implementation date: October 5, 2015
View Transmittal R3272CP.
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