Corporate Compliance

The week in Medicare updates

Medicare Insider, August 25, 2015

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Clarification regarding the processing of certain provider enrollment-related transactions

On August 14, CMS rescinded Transmittal 605, dated July 31, 2015, and replaced it with Transmittal 609 to incorporate information from change request (CR) 9139, Transmittal 592 erroneously omitted in section 15.27.2. All other information remains the same. This change request makes several minor revisions to Chapter 15 of Pub. 100-08, Medicare Program Integrity Manual.

Effective date: November 2, 2015
Implementation date: November 2, 2015

View Transmittal R609PI.

Implementation of the hospice payment reforms

On August 14, CMS released a change request implementing service intensity add-on payments for hospice social worker and nursing visits provided during the last seven days of life when provided during routine home care. In addition, this instruction will implement two routine home care rates, paying a higher rate in the first 60 days of a hospice election and a lower rate for days 61 and later.

Effective date: January 1, 2016
Implementation date: January 4, 2016

View Transmittal R3326CP.

View MLN Matters article MM9201.

October 2015 Integrated Outpatient Code Editor (I/OCE) Specifications Version 16.3

On August 14, CMS released a notification providing the Integrated OCE instructions and specifications for the Integrated OCE that will be used under the OPPS and Non-OPPS for hospital outpatient departments, community mental health centers, all non-OPPS providers, and for limited services when provided in a home health agency not under the home health prospective payment system or to a hospice patient for the treatment of a non-terminal illness. The attached recurring update notification applies to 100-04, Medicare Claims Processing Manual, Chapter 4, section 40.1.

Effective date: October 1, 2015
Implementation date: October 5, 2015

View Transmittal R3328CP.

View MLN Matters article MM9290.

New waived tests

On August 14, CMS released a change request to inform contractors of new CLIA waived tests approved by the FDA. Since these tests are marketed immediately after approval, CMS must notify its contractors of the new tests so that the contractors can accurately process claims. There are 36 newly added waived complexity tests. This recurring update notification applies to Chapter 16, section 70.8 of the Internet Only Manual.

Effective date: October 1, 2015
Implementation date: October 5, 2015

View Transmittal R3327CP.

View MLN Matters article MM9261.

IPPS final rule

On August 17, CMS posted the 2016 IPPS final rule in the Federal Register.

View the IPPS final rule in the Federal Register.

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CY 2016 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements; Correction

On August 18, CMS posted a notice in the Federal Register correcting technical errors in the proposed rule that appeared in the July 10, 2015, Federal Register entitled ‘‘Medicare and Medicaid Programs; CY 2016 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements.’’ Comments regarding this proposed rule are still due September 4.

View the correction in the Federal Register.

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