The week in Medicare updates
APCs Insider, June 12, 2015
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CMS releases coverage criteria for TAVR volume requirements
On June 1, CMS released a special edition MLN Matters® article regarding coverage criteria for individual hospitals that want to perform transcatheter aortic valve replacement (TAVR). Before a TAVR procedure is eligible for Medicare coverage, individual hospitals must meet the volume requirements specified in the TAVR National Coverage Determination. Hospitals that do not meet these volume requirements are not eligible for waivers or exceptions.
View special editionMLN Matters article SE1515.
OIG posts spring report to Congress
On June 1, the Office of Inspector General (OIG) posted its semiannual report to Congress. This report covers the period between October 1, 2014, and March 31, 2015.
View the report.
CMS releases hospital Medicare charge data
On June 1, CMS posted a fact sheet regarding the third annual update to the Medicare hospital inpatient and outpatient charge data. The data now includes inpatient and outpatient hospital charge data for 2013, as well as data released for 2011 and 2012, and shows what different hospitals in all 50 states and Washington, D.C., charge for similar services.
View the fact sheet.
View the press release.
CMS announces entrepreneur and innovator access to Medicare data
On June 2, CMS posted a new policy that for the first time will allow innovators and entrepreneurs to access CMS data, such as Medicare claims. CMS will allow innovators and entrepreneurs to conduct approved research that will ultimately improve care and provide better tools that should benefit healthcare consumers through a greater understanding of what the data says works best in healthcare. The data will not allow the patient’s identity to be determined, but will provide the identity of the providers of care. CMS will begin accepting innovator research requests in September 2015.
View the press release.
OIG posts advisory opinions on financial assistance and device subsidies
On June 4, the OIG posted an advisory opinion regarding a nonprofit, tax-exempt, charitable organization’s proposal to provide financial assistance to individuals with chronic diseases, including cancer, to assist with the costs of health insurance and drug and device therapies
The OIG also posted an advisory opinion regarding subsidies a medical device manufacturer provides to certain patients participating in a clinical research study.
View the financial assistance document.
View the device subsidy document.
CMS issues final changes to Medicare Shared Savings Program regulations
On June 4, CMS posted a fact sheet regarding a final rule that will update and improve policies governing the Medicare Shared Savings Program. CMS is making these modifications to the program regulations after considering more than 270 comments received on a wide range of issues specified in the December 2014 notice of proposed rulemaking.
View the fact sheet.
View the press release.
CGS Administrators, LLC, did not always refer Medicare cost reports and reconcile outlier payments
On June 5, the OIG posted a report stating that, of 18 Medicare-participating hospital cost reports with outlier payments that qualified for reconciliation, CGS Administrators, LLC, referred 15 cost reports to CMS in accordance with federal guidelines. However, CGS did not refer three cost reports that should have been referred to CMS for reconciliation, and one of those cost reports had not been settled.
View the report.
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