Corporate Compliance

This week in Medicare updates

Medicare Insider, February 3, 2015

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Clinical laboratory fee schedule–Medicare travel allowance fees for collection of specimens
 
On January 23, CMS released a change request revising the payment of travel allowances when billed on a per mileage basis using HCPCS code P9603 and when billed on a flat rate basis using HCPCS code P9604 for CY 2015. This recurring update notification applies to Chapter 16, section 60.2 of the Internet Only Manual.
 
Effective date: January 1, 2015
Implementation date: April 24, 2015
 
View Transmittal R3169CP.
 
View MLN Matters article MM9066.
 
Medicare Compliance Review of St. Vincent Healthcare for 2011 and 2012
 
On January 26, OIG uploaded a report detailing their compliance review of St. Vincent’s Healthcare regarding its Medicare billing practices.
 
View the report.
 
Reimbursement based on value and quality
 
On January 26, CMS posted three fact sheets to its website regarding its initiative to create and implement new payment models based on regarding value in healthcare as opposed to quantity.
 
View the fact sheet entitled “Better Care. Smarter Spending. Healthier People: Paying Providers for Value, Not Volume”.
 
View the fact sheet entitled “Better Care. Smarter Spending. Healthier People: Why It Matters”.
 
View the fact sheet entitled “Better Care. Smarter Spending. Healthier People: Improving Our Health Care Delivery System”.
 
Proposed decision for screening for the Human Immunodeficiency Virus (HIV) infection
 
On January 29, CMS posted a proposed decision memorandum stating its proposal to expand coverage in section 210.7 of the Medicare National Coverage Determinations (NCD) Manual.  CMS proposes the evidence is adequate to conclude that screening for HIV infection for all individuals between the ages of 15 and 65 years, as is recommended with a grade of A by the United States Preventive Services Task Force (USPSTF), is reasonable and necessary for the early detection of HIV and is appropriate for individuals entitled to benefits under Part A or enrolled under Part B.
 
View the proposed decision memorandum.
 
Payment codes on home health claims will be matched against patient assessments
 
On January 30, CMS released special edition MLN Matters article SE1504 regarding HHAs submitting claims to MACs for services provided to Medicare beneficiaries. Beginning on April 1, 2015, Medicare systems will compare the Health Insurance Prospective Payment System (HIPPS) code on a Medicare home health claim to the HIPPS code generated by the corresponding Outcomes and Assessment Information Set (OASIS) assessment before the claim is paid.
 
View special edition MLN Matters article SE1504.



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