Corporate Compliance

This week in Medicare updates

Medicare Insider, November 11, 2014

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One on One Education
On October 31, CMS released a change request to provide a definition for one on one education. Contractors provide one on one education to providers/suppliers.   
Effective date: December 2, 2014
Implementation date: December 2, 2014
View Transmittal R550PI.
Policy and payment changes to the Medicare Physician Fee Schedule (PFS) for 2015: Changes for Calendar Year 2015 Physician Quality Programs and other programs in the Medicare PFS
On October 31, CMS issued a final rule that updates payment policies and payment rates for services furnished under the Medicare PFS on or after January 1, 2015. Medicare primarily pays physicians and other practitioners for care management services as part of face-to-face visits. CMS also posted a fact sheet regarding the changes to these quality reporting programs and other programs included in this rule, as well as a fact sheet regarding the policies for implementing the Value Modifier.
View the final rule.
View CMS’ physician fee schedule website.
View the policy and payment fact sheet.
View the quality programs fact sheet.
View the Value Modifier implementation fact sheet.
Hospital Outpatient Prospective Payment and ASC Payment Systems and Quality Reporting Programs; Physician-Owned Hospitals: Data Sources for Expansion Exception; Physician Certification of Inpatient Hospital Services; Medicare Advantage Organizations and Part D Sponsors: CMS-Identified Overpayments Associated with Submitted Payment Data
On October 31, CMS posted a final rule with comment period revises the Medicare hospital OPPS and the Medicare ASC payment system for CY 2015 to implement applicable statutory requirements and changes. In this final rule with comment period, CMS describes the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program.
View the final rule with comment period.
View the notice on CMS’ outpatient hospital website.
View the fact sheet regarding hospital outpatient and ASC payment changes.
View the fact sheet regarding hospital outpatient and ASC quality reporting changes.
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Effect on microbiology laboratories due to the removal of references to the Clinical Laboratory Standards Institute (CLSI) and to CLSI Documents
On October 31, CMS posted a document regarding the removal of CLSI references. CLSI document references will be removed from the upcoming revision of the Survey Procedures and Interpretive Guidelines for Laboratories and Laboratory Services. For CLIA quality control (QC) compliance in each time frame.
View the survey and certification requirements.
Reporting the Service Location NPI on Anti-Markup and Reference Laboratory Claims
On November 3, CMS released a change request providing guidance for physicians and suppliers billing anti-markup and reference laboratory claims. Physicians and other suppliers will no longer be permitted to submit their own NPI in Item 32a (or its electronic equivalent) when the performing physician or supplier is located in another jurisdiction. The changes that will be implemented in PECOS will allow contractors the ability to verify all physician and supplier NPIs, regardless of the jurisdiction in which they are enrolled. Transmittal 3098, dated October 21, 2014, is being rescinded and replaced by Transmittal 3103 to correct the effective and implementation date. A business requirement has been added for the A/B MACs. All other information remains the same.
Effective date: January 1, 2015, for Analysis, Design, and Programming; April 1, 2015, for Testing and Implementation
Implementation date: January 5, 2015; April 6, 2015, for MAC testing of PECOS changes
View Transmittal R3103CP.
Update regarding Hospital Appeals Settlement offer
On November 5, CMS updated the language on its inpatient hospital website regarding the Hospital Appeals Settlement offer. The deadline to submit a request for settlement has now passed.
View the updated website.
Updated to Probe and Educate
On November 5, CMS updated the information available regarding Probe and Educate review on its inpatient hospital website. It states that all MACs have completed the first probe reviews and associated education. ALL MACs have begun their second probe reviews with some providers having already completed the second probe.
View the updated website.
Speech generating devices
On November 6, CMS opens a benefit category determination NCD process and 30-day public comment period begins regarding speech generating devices. Since the implementation of rules regarding these devices, the technology of devices that generate speech and the ways in which the devices are used by patients to meet their medical needs has changed significantly. Therefore, CMS is internally generating a reconsideration of this NCD to address coverage of devices that generate speech as well as other forms of communication.
View the notice.
CLIA; Fecal Occult Blood (FOB) testing
On November 7, CMS posted a proposed rule in the Federal Register that would amend the CLIA regulations to clarify that the waived test categorization applies only to nonautomated fecal occult blood tests. In addition, the proposed rule would remove the hemoglobin by copper sulfate method from the list of waived tests if commenters confirm that the method is no longer used. Comments are due January 6, 2015.
View the proposed rule in the Federal Register.
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