Corporate Compliance

Transmittals and MLN Matters articles: CMS updates interest rate, clotting factor fee, and more

Medicare Insider, October 27, 2009

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CMS issues reasonable charge update

On October 23, CMS issued a transmittal to update the reasonable charge for splints, casts, dialysis supplies, dialysis equipment, and certain intraocular lenses.

Effective date: January 1, 2010
Implementation date: January 4, 2010

View the transmittal.

CMS replaces previous instructions for coverage of IRF services

On October 23, CMS issued a transmittal in which it replaced previous manual sections that describe coverage of inpatient rehabilitation services provided in inpatient rehabilitation facilities (IRF). CMS made the changes pursuant to recent regulatory changes that can be found in 42 CFR 412.622 (74 FR 39762 (August 7, 2009)).

Effective date: For IRF discharges occurring on or after January 1, 2010
Implementation date: January 4, 2010

View the transmittal.

CMS clarifies role in obtaining OCR clearance

On October 16, CMS issued a transmittal in which it made revisions to the State Operations Manual sections regarding ascertaining compliance with the Office for Civil Rights (OCR) requirements.

Effective date: October 16, 2009
Implementation date: October 16, 2009

View the transmittal.

CMS updates clotting factor furnishing fee

On October 16, CMS issued its annual update to the clotting factor furnishing fee.

Effective date: January 1, 2010
Implementation date: January 4, 2010

View the transmittal.

View a related MLN Matters article.

View a related Job Aid article.

CMS updates overpayment/underpayment interest rate

On October 15, CMS implemented the quarterly update to its interest rate for Medicare overpayments and underpayments. CMS instructed contractors to implement an interest rate of 10.875 percent effective October 22, 2009.

Effective date: October 22, 2009
Implementation date: October 22, 2009

View the transmittal.

CMS updates FDG PET transmittals

On October 16, CMS rescinded and replaced previous transmittals on its new coverage framework for FDG PET for solid tumors and myeloma. The effective date has been changed to April 3, 2009, and the implementation date has been changed to October 30, 2009. Some business requirements have been revised. All other information remains the same.

Effective date: April 30, 2009
Implementation date: October 30, 2009

View the transmittal to the NCD Manual.

View the transmittal to the Claims Processing Manual.

View a related MLN Matters article.

CMS updates 5010 transmittal

On October 16, CMS rescinded and replaced a previous transmittal that instructs the Medicare Administrative Contractors and the Shared System Maintainers to implement the changes in version 5010 of transaction 835 - Health Care Claim/Payment Advice and Updated Standard Paper Remit (SPR).

Effective date: January 1, 2010
Implementation Date: January 4, 2010 for A/B MACs, DME MACs, and FISS; January 4, 2010 and April 5, 2010 for VMS; July 5, 2010 for MCS

View the transmittal.

CMS reconsiders blanket non-coverage of MRI for blood flow determination

On October 16, CMS issued transmittals finding that the blanket non-coverage of MRI for blood flow determination at section 220.2 of the NCD Manual is no longer supported by the available evidence. Therefore, CMS is removing the phrase “blood flow measurement” from the NCD, giving local Medicare contractors discretion to cover (or not cover) this.

Effective date: September 28, 2009
Implementation date: January 4, 2010

View the transmittal to the Claims Processing manual.

View the transmittal to the NCD Manual.

View a related MLN Matters article.



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