Revenue Cycle

Important Medicare Updates

Medicare Update for CAHs, August 22, 2012

CMS issues interim final rule for healthcare EFT and RA transactions

On August 10, CMS issued an interim final rule that implements part of section 1104 of the Affordable Care Act which requires the adoption of operating rules for the healthcare electronic funds transfers (EFT) and remittance advice transaction.

View the interim final rule.

View a related fact sheet.

View a related press release.

CMS issues NCD for TENS for chronic low back pain (160.27)

On August 7, CMS issued a national coverage determination (NCD) for transcutaneous electrical nerve stimulation (TENS) for chronic low back pain (160.27).

View the NCD.

OIG issues review on payments in Jurisdiction 12 for Herceptin

On August 6, the OIG issued a review which found that most Medicare payments that were made to providers in four of the five states in Jurisdiction 12 Delaware, the District of Columbia, New Jersey, and Pennsylvania) from January 2008 through December 2010 were incorrect. Of 1,454 line items reviewed, 1,165 were incorrect and included overpayments totaling $1.6 million.

View the OIG report.

OIG issues review on payments in Jurisdiction 6 for Herceptin

On August 6, the OIG issued a review which found that most Medicare payments that Noridian Administrative Services made to providers for full vials of Herceptin were incorrect. Of 464 line items reviewed, 368 were incorrect and included overpayments totaling $557,000.

View the OIG report.

CMS issues an NCA for autologous blood-derived products for chronic non-healing wounds (CAG-00190R3)

On August 2, CMS issued a national coverage analysis (NCA) for autologous blood-derived products for chronic non-healing wounds (CAG-00190R3).

View the NCA.

CMS issues transmittal on transcutaneous electrical nerve stimulation for chronic low back pain

On August 3, CMS issued a transmittal that informs contractors that effective for claims with dates of service on or after June 8, 2012, Medicare will only allow coverage of TENS for CLBP defined for this decision as pain for more than three months and not a manifestation of a clearly defined and generally recognizable primary disease entity, when the patient is enrolled in an approved clinical study under coverage with evidence development (CED).

Effective date: June 8, 2012

Implementation date: January 7, 2012

View the Claims Processing Manual transmittal.

View the National Coverage Determination Manual transmittal.

View MLN Matters article MM7836.

OIG issues report on inappropriate and questionable billing by home health agencies

On August 2, the OIG issued a review of Medicare home health agency payments in 2010. The review found that in 2010, Medicare inappropriately paid $5 million for home health claims with three specific errors: overlapping with claims for inpatient hospital stays, overlapping with claims for skilled nursing facility stays, or billing for services on dates after beneficiaries' deaths.

View the OIG report.
 
CMS issues Part A SNF PPS pricer update for FY2013

On August 2, CMS issued a transmittal that provides information on the updates to the payment rates used under the PPS for SNFs, for FY 2012, as required by statute. The update can be found in Chapter 6, Section 30.7 of the Claims Processing Manual.

Effective date: October 1, 2012

Implementation date: October 1, 2012

View transmittal R2507CP.

View MLN Matters article MM7907.

CMS releases 2013 IPPS final rule

On August 1, CMS issued a display copy of the 2013 inpatient prospective payment system final rule. Highlights of the rule include proposed changes to the list of complications and comorbidities (CC) and major CCs (MCC), the addition of two conditions to the list of hospital-acquired conditions, and finalized operational details for the value-based purchasing program.

View an an HCPro analysis.

View the display copy final rule.

View a related fact sheet.

View a related fact sheet on quality of care.

View a related press release.

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