Corporate Compliance

Transmittals and MLN Matters articles: CMS posts special article on admission screening criteria, implements lab payment demonstration, and more

Medicare Insider, February 1, 2011

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CMS issues special article on inpatient admission decisions

CMS has posted a special edition MLN Matters article on inpatient admission decisions and the use of screening criteria – including Interqual and Milliman – by CMS contractors such as RACs, CERT, and the FIs/MACs. CMS states that it “considers the use of screening criteria as only one tool that should be utilized by contractors to assist them in making an inpatient hospital claim determination.”

View the special edition article.

CMS implements PPACA lab payment demonstration

On January 28, CMS issued two transmittals to put in place a demonstration project for certain complex diagnostic lab tests, as mandated by the Patient Protection and Affordable Care Act. The demonstration will establish a separate payment method for these tests with a date of service that would under standard Medicare rules, be bundled into the payment for an associated hospital inpatient stay.

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

View the Claims Processing Manual transmittal.

View the Demonstrations Manual transmittal.

CMS posts POA/5010 instructions

On January 28, CMS issued a transmittal to instruct contractors regarding the present-on-admission (POA) indicator and version 5010 claim submission. This transmittal modifies FISS logic to auto-populate POA indicator "Z" for IPPS hospitals using 5010.

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

View the transmittal.

CMS clarifies items/services included in ESRD rate

On January 28, CMS issued a transmittal to clarify those items and services that are included within and paid for under the end-state renal disease (ESRD) composite rate.

Effective date: January 1, 2011
Implementation date: February 25, 2011

View the transmittal.

CMS updates DSMT language

On January 28, CMS issued a transmittal to make minor updates to the Program Integrity Manual regarding diabetes self-management training (DSMT).

Effective date: March 30, 2009
Implementation date: April 29, 2011

View the transmittal.

CMS replaces transmittal

CMS rescinded and replaced a transmittal previously outlined in Medicare Weekly Update. The replacement transmittal has details about the Medicare and Medicaid Extenders Act of 2010 extension of the hold harmless payments to small rural hosptials, sole community hospitals (SCHs) and essential access community hospitals (EACHs) at 85% of the hold harmless rate. 

 



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