Health Information Management

Medicare Updates

APCs Insider, April 12, 2013

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CMS issues changes to data reporting on home health PPS claims

On April 2, CMS issued a transmittal that adds new data reporting requirements for home health PPS claims.
View transmittal R2680CP.
 
CMS issues transmittal regarding incentive payment related to prior authorization for power mobility devices
On April 5, CMS issued a transmittal about incentive payment related to prior authorization for power mobility devices.
 View transmittal R1205OTN.
 
CMS issues quarterly update for DMEPOS Competitive Bidding Program
On April 5, CMS issued a transmittal with the quarterly update for the Durable Medical Equipment Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program (CBP).
View transmittal R2678CP.
 
CMS issues update for claim status category and claim status codes
On April 5, CMS issued a transmittal updating claim status and claim status category codes for use by Medicare contractors with the Health Care Claim Status Request and Response ASC X12N 276/277, Health Care Claim Acknowledgement ASC X12N 277.
View transmittal R2681CP.
 
CMS issues update to Common Edits and Enhancements Modules (CEM) code set
On April 5, CMS issued a transmittal updating the CEM code set.
View transmittal R2684CP.
 
CMS issues update to non-systems Internet Only Manual (IOM)
On April 5, CMS issued a transmittal that states that per the National Uniform Billing Committee (NUBC), Form Locator (FL) 66 – Diagnosis and Procedure code Qualifier (ICD Version Indicator) is required for all hardcopy institutional claims. This change request only updates the Internet Only Manual (IOM). Systems changes have already been completed.
View transmittal R2683CP.
 
OIG issues Special Fraud Alert: Physician-Owned Entities memo
On March 26, the OIG issued a Special Fraud Alert that addresses physician-owned entities that derive revenue from selling, or arranging for the sale of, implantable medical devices ordered by their physician-owners for use in procedures the physician-owners perform on their own patients at hospitals or ambulatory surgical centers (ASCs).
View the Special Fraud Alert.
 
OIG issues report on CMS oversight of private health insurance submissions to the HealthCare.gov Plan Finder
On April 1, the OIG released a report based on a study of the HealthCare.gov Plan Finder, which is a comprehensive, online portal that assists consumers in comparing their health insurance coverage options. The OIG reviewed CMS's policies and procedures, survey responses, and interview responses regarding oversight of insurers' data submissions. Then the OIG made recommendations to CMS based on their findings.
View the report.
 
Final rule issued regarding the increased federal medical assistance percentage changes under the Affordable Care Act of 2010
On April 2, a final rule was published in the Federal Register that implements the provisions of the Patient Protection and Affordable Care Act of 2010 and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act) relating to the availability of increased Federal Medical Assistance Percentage (FMAP) rates for certain adult populations under states’ Medicaid programs. This final rule implements and interprets the increased FMAP rates that will be applicable beginning January 1, 2014 and sets forth conditions for states to claim these increased FMAP rates.
View the final rule.
 
Proposed rule issued regarding Medicare/Medicaid survey, certification and procedures
On April 5, a proposed rule was issued in the Federal Register that proposes a revision to the survey, certification, and enforcement procedures related to CMS oversight of national accreditation organizations (AOs). These revisions would implement certain provisions under the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).
View the final rule.



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