Corporate Compliance

Transmittals and MLN Matters articles: CMS makes timely filing changes, modifies IPPS Pricer, and more

Medicare Insider, January 25, 2011

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CMS implements timely filing changes

On January 21, CMS issued a transmittal to update its manual system with changes to the timely filing requirements, under the Patient Protection and Affordable Care Act (PPACA). PPACA reduces the maximum period for submission of all Medicare fee-for-service claims to no more than 12 months after the date of service.

Effective date: Janaury 1, 2010
Implementation date: February 22, 2011

View the transmittal.

CMS to modify CWF for benefit periods over 10 years

On January 21, CMS issued a transmittal to implement changes to the common working file (CWF) to allow benefit periods longer than 10 years.

Effective date: October 1, 2002
Implementation date: July 5, 2011

View the transmittal.

CMS modifies IPPS Pricer

On January 21, CMS issued a transmittal to make an off-cycle change to the IPPS Pricer related to the low-volume payment adjustment.

Effective date: July 1, 2011
Implementation date: July 5, 2011

View the transmittal.

CMS revises ESRD comorbidities

On January 21, CMS issued a transmittal to remove ICD-9-CM diagnosis codes 484.6 and 484.7 from the bacterial pneumonia comorbidity category. These two diagnoses that are not eligible for a comorbidity payment adjustment under the ESRD PPS

Effective date: January 1, 2011
Implementation date: July 5, 2011

View the transmittal.

CMS clarifies CAH payment calculation

On January 21, CMS issued a transmittal to clarify the payment calculation for non-medically directed certified registered nurse anesthetist (CRNA) services in a Method II CAH without a CRNA pass-through exemption.

Effective date: July 1, 2007
Implementation date: July 5, 2011

View the transmittal.

CMS extends reasonable cost payment of certain lab tests

On January 21, CMS issued a transmittal to extend reasonable cost payment for clinical lab tests performed by hospitals with fewer than 50 beds in qualified rural areas as part of their outpatient services for cost reporting periods beginning on or after July 1, 2011, through June 30, 2012. The extension falls under the Medicare and Medicaid Extenders Act of 2010.

Effective date: For cost reporting periods beginning on or after July 1, 2011, through June 30, 2012
Implementation date: July 5, 2011

View the transmittal.

CMS issues quarterly drug pricing update

On January 21, CMS issued a transmittal to implement the April 2011 quarterly average sales price (ASP) Medicare Part B drug pricing files and make revisions to prior quarterly pricing files.

Effective date: April 1, 2011
Implementation date: April 4, 2011

View the transmittal.

CMS posts updated interest rates

On January 14, CMS issued a transmittal to implement a quarterly update to the interest rate that applies to overpayments and underpayments. Effective January 24, CMS instructed contractors to implement an interest rate of 11.25%.

Effective date: April 1, 2011
Implementation date: April 4, 2011

View the transmittal.

CMS updates lab NCDs

On January 14, CMS issued a transmittal to implement the lab NCD update for second quarter 2011.

Effective date: April 1, 2011
Implementation date: April 4, 2011

View the transmittal.

CMS replaces transmittal

CMS rescinded and replaced a transmittal previously outlined in Medicare Weekly Update.



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