Health Information Management

The week in Medicare updates

APCs Insider, June 19, 2015

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CMS releases July 2015 update of the hospital OPPS 
On June 5, CMS released the recurring update notification describing changes to and billing instructions for various payment policies implemented in the July 2015 OPPS update. The July 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. It applies to Chapter 4 of the Medicare Claims Processing Manual, section 20.6.11. 
Effective date: July 1, 2015
Implementation date: July 6, 2015 
View Transmittal R3280CP
View MLN Matters article MM9205.
 
CMS releases July 2015 update of the ASC payment system 
On June 5, CMS released a recurring update notification describes changes to billing instructions for various payment policies implemented in the July 2015 ambulatory surgical center payment system update. This recurring update notification applies to Chapter 14 of the Medicare Claims Processing Manual, section 10. 
Effective date: July 1, 2015
Implementation date: July 6, 2015 
View Transmittal R3279CP
View MLN Matters article MM9207.
 
CMS releases resources for submitting correct ICD-10 codes to Medicare 
On June 8, CMS released a special edition MLN Matters article aimed toward all physicians, providers, and suppliers who submit claims to MACs, including home health & hospice and DME MACs, for services provided to Medicare beneficiaries. It includes links and resources intended to assist in submitting correct ICD-10 codes to Medicare. 
View special edition MLN Matters article SE1518.
 
CMS releases article on using ICD-10-PCS Section X codes 
On June 9, CMS released a special edition MLN Matters article intended to assist hospital providers by offering details about the new ICD-10-PCS Section X (New Technology), as well as specific coding instruction for the new section. 
View special edition MLN Matters article SE1519.
 
CMS posts final rule for accountable care organizations
On June 9, CMS posted a final rule in the Federal Register addressing changes to the Medicare Shared Savings Program (MSSP) including provisions relating to the payment of accountable care organizations (ACO) participating in the MSSP. Providers and suppliers that participate in an ACO continue to receive traditional Medicare fee-for-service payments under Parts A and B and may be eligible to receive a shared savings payment if it meets specified quality and savings requirements. With the exception of the amendments to §§ 425.312, 425.704, and 425.708, the provisions of this final rule are effective on August 3, 2015. 
View the notice in the Federal Register.
 
OIG post fraud alerts regarding physician compensation arrangements 
On June 9, the Office of Inspector General posted a fraud alert stating physicians who enter into compensation arrangements such as medical directorships must ensure that those arrangements reflect fair market value for bona fide services the physicians actually provide. 
View the fraud alert.
 
CMS announces MAC contract for Jurisdiction M 
On June 12, CMS released a change request to announce the award of the A/B MAC Jurisdiction M contract to Palmetto GBA for the administration of Medicare Part A and Part B fee-for-service claims as well as the home health and hospice Region C service area.
Effective date: April 1, 2015
Implementation date: July 13, 2015 
View Transmittal R1510OTN.



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