Health Information Management

The week in Medicare updates

APCs Insider, July 17, 2015

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OIG releases report on drugs commonly used by dual-eligible beneficiaries
On July 1, the Office of Inspector General (OIG) posted a memorandum to fulfill the annual reporting mandate from the Patient Protection and Affordable Care Act (ACA) for 2015. The ACA requires that the OIG conduct a study of the extent to which formularies used by stand-alone prescription drug plans and Medicare Advantage prescription drug plans (referred to jointly as Part D plans) under Medicare Part D include drugs commonly used by full-benefit dual-eligible individuals (i.e., individuals who are eligible for both Medicare and full Medicaid benefits).
View the memorandum.
CMS updates information for ICD-10 end-to-end testing
On July 2, CMS rescinded Transmittal 1481, dated March 27, 2015, and replaced it with Transmittal 1517 to remove the requirement for report files to be password protected and clarify how files should be sent to CMS. All other information remains the same. The original transmittal requires MACs to produce a report for each tester that provides the final status of each claim that was submitted.
Effective date: April 27, 2015
Implementation date: May 29, 2015
View Transmittal R1517OTN.
CMS updates Remittance Advice section of Medicare manual
On July 2, CMS released a change request to modify the current version of the Medicare Claims Processing Manual, Chapter 22 Remittance Advice, to remove outdated information. Additional clarification has been added to this chapter.
Effective date: August 3, 2015
Implementation date: August 3, 2015
View Transmittal R3288CP.
Medicare contractor overpaid provider that incorrectly billed for aflibercept
On July 6, the OIG posted a report stating that Wisconsin Physicians Service Insurance Corporation, a Medicare contractor for Iowa, Kansas, Missouri, and Nebraska, overpaid a provider by $432,000 for incorrectly billed aflibercept.
View the report.
CMS proposes comprehensive care model for joint replacement
CMS posted a proposed rule in the Federal Register regarding a new comprehensive care for joint replacement model meant to address the fragmentation present in the current system when a beneficiary requires a joint replacement by focusing on coordinated, patient-centered care. This model aims to improve the care experience for the many and growing numbers of Medicare beneficiaries who receive joint replacements.
View the proposed rule in the Federal Register.
View the fact sheet.
CMS issues national coverage analysis for human papillomavirus testing
On July 9, CMS posted a final decision memorandum stating that the evidence is sufficient to add human papillomavirus testing once every five years as an additional preventive service benefit under the Medicare program for asymptomatic beneficiaries aged 30 to 65 years in conjunction with the Pap smear test. CMS will cover screening for cervical cancer with the appropriate FDA-approved/cleared laboratory tests, used consistently with FDA-approved labeling, and in compliance with Clinical Laboratory Improvement Amendments regulations.
View the decision memorandum

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