Revenue Cycle

Important Medicare updates

Medicare Update for CAHs, November 28, 2012

CMS issues press release on ACA impact on payments to primary care physicians

On November 2, CMS issued a press release in which HHS Secretary Kathleen Sebelius announced that the final rule implementing the part of the healthcare law that delivers higher payments to primary care physicians serving Medicaid beneficiaries.

View the press release.

CMS replaces transmittal on implementation of changes to ESRD PPS consolidated billing requirements

On November 5, CMS replaced transmittal R2504CP, containing an update to the billing requirements for Daptomycin and clarifies outlier services for CY 2013.

Effective date: January 1, 2013

Implementation date: January 7, 2013

View transmittal R2588CP.

CMS issues erroneous partial episode payment adjustments on certain home health dual-eligible claims

On November 2, CMS issued a transmittal which corrects the situation where in TPL demand bill situations, overlapping HH episodes sometime cause Medicare claims to be paid partial episode payments (PEPs) in error, by creating adjustments to restore full payment when the fully denied demand bill is processed.

Effective date: HH PPS episodes ending on or after January 1, 2010

Implementation date: April 1, 2013

View transmittal R2583CP.

View MLN Matters article MM7865.

CMS issues transmittal on new erythropoietin stimulating agent peginesatide requirements for ESRD

On November 2, CMS issued a transmittal which states that Peginesatide drug added to drugs subject to the ESRD ESA billing requirements, including the ESRD ESA claims monitoring policy. 

Effective date: April 1, 2013

Implementation date: April 1, 2013

View transmittal R2582CP.

CMS issues transmittal on implementation of changes in the ESRD PPS

On November 2, CMS issued a recurring update notification that implements the third year of the ESRD PPS 4-year transition period and the calendar year 2013 rate updates for the basic case-mix adjusted composite payment system portion of the blended payment amount and the ESRD PPS.

Effective date: January 1, 2013
Implementation date: January 7, 2013

View transmittal R162BP.

CMS issues 2013 OPPS final rule in Federal Register

On November 13, CMS issued the 2013 OPPS final rule in the Federal Register after releasing the display copy on November 2.

View the final rule.
Submit a comment.

CMS issues 2013 physician fee schedule final rule in Federal Register

On November 13, CMS issued the 2013 physician fee schedule final rule in the Federal Register after releasing the display copy on November 2.

View the final rule.
Submit a comment.

OIG issues review of Medicare appeals at the Administrative Law Judge level

On November 15, the OIG issued a review of ALJ appeals decided in fiscal year 2010 which found that when CMS participated in appeals, ALJ decisions were less likely to be favorable to appellants. In addition, the OIG raised concerns about the acceptance of new evidence and the organization of case files.

View the OIG report.

OIG issues review of payments to skilled nursing facilities in 2009

On November 13, the OIG issued a review of payments made to skilled nursing facilities in 2009, which found that SNFs billed one-quarter of all claims in error that year, resulting in $1.5 billion in inappropriate Medicare payments.

View the OIG report.

CMS issues home health prospective payment system rate update for CY2013

On November 16, CMS issued a transmittal that updates the 60-day national episode rates, the national per-visit amounts, LUPA add-on amount, the non-routine medical supply payment amounts, the fixed dollar loss ratio, and the labor and non-labor percentages under the HH PPS for CY 2013.
Effective date: January 1, 2013

Implementation date: January 7, 2013

View transmittal R2592CP.

CMS issues transmittal on use of Q6 modifier for locum tenens by providing performing provider NPI

On November 16, CMS issued a transmittal which instructs on the use of HCPCS Q6 modifier as it pertains to the use of substitute services.

Effective date: April 1, 2013

Implementation date: April 1, 2013

View transmittal R1151OTN.

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