The week in Medicare updates
APCs Insider, September 4, 2015
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CMS updates National Coverage Determination Manual for speech generating devices
On August 21, CMS released a change request providing updates to add a revised scope of benefit NCD for speech-generating devices covered under the Medicare benefit category for durable medical equipment.
Effective date: July 29, 2015
Implementation date: September 21, 2015
View Transmittal R184NCD.
CMS issues October 2015 taxonomy code update
On August 21, CMS released a transmittal stating affected Medicare contractors shall obtain the most recent Healthcare Provider Taxonomy Codes (HPTC) code set and use it to update their internal HPTC tables and/or reference files. The recurring update notification applies to Chapter 24 of the Medicare Claims Processing Manual, Section 60.6.
Effective date: October 1, 2015
Implementation date: January 4, 2016 though contractors with the capability to do so shall implement this change request effective October 1, 2015
View Transmittal R3336CP.
CMS updates Clotting Factor Furnishing Fee for 2016
On August 21, CMS released an annually recurring change request announcing the update to the Clotting Factor Furnishing Fee. This recurring update notification affects Chapter 17 of the Medicare Claims Processing Manual, § 80.4.1.
Effective date: January 1, 2016
Implementation date: January 4, 2016
View Transmittal R3340CP.
CMS releases October 2015 update of the hospital OPPS
On August 21, CMS released a recurring update notification describing changes to and billing instructions for various payment policies implemented in the October 2015 OPPS update. The October 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.
Effective date: October 1, 2015
Implementation date: October 5, 2015
View Transmittal R3333CP.
CMS releases ICD-10 conversion/coding infrastructure revisions to NCDs
On August 21, CMS released the third maintenance update of ICD-10 conversions/updates specific to NCDs. Edits to ICD-10 coding specific to NCDs will be included in subsequent quarterly updates as needed. No policy-related changes are included with these updates. Any policy-related changes to NCDs continue to be implemented via the current, long-standing NCD process.
Effective date: October 1, 2015
Implementation date: January 4, 2016.
Exceptions: FISS will implement the following NCDs April 4, 2016:
- 260.1
- 80.11
- 20.16
- 270.6
- 160.18
- 110.10
- 110.21
- 250.5
- 100.1
- 160.24
View Transmittal R1537OTN.
View ZIP files under R1537OTN1.
Medicare Accountable Care Organizations (ACO) provide improved care while slowing cost growth in 2014
On August 25, CMS posted a fact sheet regarding 2014 quality and financial performance results showing that Medicare ACOs continue to improve the quality of care for Medicare beneficiaries, while generating financial savings. As the number of Medicare beneficiaries served by ACOs continues to grow, these results suggest that ACOs are delivering higher quality care to more and more Medicare beneficiaries each year.
View the fact sheet.
View the press release.
CMS posts solicitation of nominations to the Advisory Panel on Hospital Outpatient Payment
On August 28, CMS posted a notice in the Federal Register soliciting nominations for up to seven new members to the Advisory Panel on Hospital Outpatient Payment. There will be vacancies on this panel for four-year terms that begin during calendar year 2016. The purpose of this panel is to advise HHS and CMS on the clinical integrity of the APC groups and their associated weights, and supervision of hospital outpatient therapeutic services. HHS rechartered this panel in 2014 for a two-year period effective through November 6, 2016.
View the notice in the Federal Register.
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