Health Information Management

The week in Medicare updates

APCs Insider, June 14, 2013

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Pass-through payments for CRNA anesthesia services and related care

On June 7, CMS issued a transmittal clarifying that effective January 1, 2013, qualifying critical access hospitals and rural hospitals are eligible to receive CRNA pass-through payments for services that a CRNA is legally authorized to perform in the state in which the services are furnished.
Effective date: January 1, 2013
Implementation date: September 9, 2013
View transmittal R2719CP
 
Revised Appendix A, Interpretive Guidelines for Hospitals, Appendix L, Interpretive Guidelines for Ambulatory Surgical Centers, and Appendix W, Interpretive Guidelines for Critical Access Hospitals
On June 7, CMS issued a transmittal to revise regulations adopted for hospitals in 42 CFR Part 482, ambulatory surgical centers in 42 CFR Part 416, and critical access hospitals in 42 CFR Part 485, Subpart F.
View transmittal R84SOMA.
 
Implementation of the Award for the Jurisdiction K (JK) Part A and Part B Medicare Administrative Contractor (A/B MAC) to National Government Services
On June 7, CMS issued a transmittal to implement the Jurisdiction K (JK) A/B MAC award to National Government Services.
Effective date: October 1, 2013
Implementation date: October 7, 2013
View transmittal R1246OTN.
 
July 2013 Update of the Hospital Outpatient Prospective Payment System (OPPS)
On June 7, CMS issued a transmittal to describe changes to and billing instructions for various payment policies implemented in the July 2013 OPPS update.
Effective date: July 1, 2013
Implementation date: July 1, 2013
View transmittal R2718CP.
 
Implementing the Recompetition Award for the Jurisdiction L (formerly Jurisdiction 12) Part A/Part B Medicare Administrative Contractor (A/B MAC) Workload
On June 7, CMS issued a transmittal stating that the Jurisdiction L A/B MAC recompetition procurement was awarded to the incumbent contractor, Novitas Solutions, Inc.
Effective date: July 1, 2013
Implementation date: July 1, 2013
View transmittal R1245OTN.
 
Removal of POR and PSOR instructions and the Glossary of Acronyms from the Internet Only Manual, Publication 100.06, Chapter 3
On June 7, CMS issued a change request to remove all instructions in the IOM Publication 100.06, Chapter 3 related to POR and PSOR systems and the Glossary of Acronyms. These systems are retired and the Glossary of Acronyms is outdated.
Effective date: July 9, 2013
Implementation date: July 9, 2013
View transmittal R220FM
 
Implementation of the End Stage Renal Disease (ESRD) Prospective Payment System (PPS)
On June 7, CMS issued a transmittal to update and reorganize the ESRD chapter in the Medicare Benefit Policy Manual to reflect the ESRD PPS.
Effective date: January 1, 2011
Implementation date: September 9, 2013
View transmittal R171BP.
View MLN Matters article MM8261.
 
Revisions to Chapter 7–Risk Adjustment
On June 7, CMS issued a transmittal to revise Chapter 7 significantly by focusing it only on risk adjustment, retitling it accordingly, and moving the topic of payments to Medicare Advantage Organizations to Chapter 8. It now includes much more information on risk adjustment since the last revision, including background on the statutory and regulatory authority for risk adjustment, the history of risk adjustment, a schedule, and information on the Part D (RxHCC) model.
View transmittal R114MCM.
 
Changes to the Provider Reimbursement Manual
On June 7, CMS issued a transmittal to clarify existing instructions, incorporate statutory changes and comply with an Executive Order as it relates to Part 2, Provider Cost Reporting Forms and Instructions, Chapter 42, Form CMS-265-11.
View transmittal R2P242.
 
Autologous Platelet-rich Plasma (PRP) for Chronic Non-healing Wounds
On June 10, CMS issued a change request to include attachments that should have been included for previous transmittals.
View transmittal R2720CP.
 
Implementation of CMS Ruling 1455-R (Medicare Program; Part B Billing in Hospitals)
On June 10, CMS issued a change request to correct coding and remarks requirements for Part B claim in BR 8277.17 and BR8277.18.
View transmittal R1247OTN.
 
OIG releases Sequestration Operating Plan for FY2013
On June 6, the OIG released the Sequestration Operating Plan for FY2013.
View the release.
 
OIG issues report on comparing lab test payment rates
On June 10, OIG issued a report comparing lab test payment rates and found that in 2011, Medicare paid 18%-30% more than other insurers for 20 high-volume and/or high-expenditure lab tests, and could have saved $910 million (38%) on these lab tests if it had paid providers at the lowest established rate in each geographic area.
View the report.



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