Health Information Management

This week's Medicare updates

APCs Insider, July 26, 2013

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Revised Appendix A, Interpretive Guidelines for Hospitals, Conditions of Participation: Discharge Planning

On July 19, CMS issued a transmittal to clarify the provisions of 42 CFR 482.43, concerning discharge planning. Several “Tags” within this CoP guidance have also been consolidated, but there are no changes to the regulatory text.

View transmittal R87SOMA

Revisions to State Operations Manual (SOM) Chapter 5

On July 19, CMS issued a transmittal stating that it is reorganizing and updating Chapter 5, Sections 5100 through 5170 of the State Operations Manaul. Corresponding to these revisions, it is updating Exhibit 294 and deleting Exhibit 295.

View transmittal R86SOMA

Federally Qualified Health Center (FQHC) Medicare participation

On July 19, CMS issued a transmittal to make clarifications regarding Medicare participation requirements for FQHCs, including determination of the effective date of participation. CMS revised Chapter 2, Sections 2826C through 2826 F, as well as Exhibit 177 and Exhibit 179.

View transmittal R85SOMA

Medicare Appeals System (MAS) Level 1 Implementation

On July 19, CMS issued a transmittal to notify the contractors of the upcoming outreach efforts and gathering sessions CMS will require in support of the Medicare Appeals System (MAS) Level 1 Implementation. The first phase of the Level 1 implementation will focus on Part A.

Effective date: November 28, 2012 – MAS Level 1 implementation effort

Implementation date: August 19, 2013

View transmittal R1257OTN.

PIM Chapter 6 MR Guidelines

On July 19, CMS issued a transmittal to update section 6.5.4 to include MAC referral to QIO of quality of healthcare concerns.

Effective date: August 19, 2013

Implementation date: August 19, 2013

View transmittal R475PI.

CMS announces new “OPEN PAYMENTS” mobile applications to assist physicians & industry in tracking financial relationships

On July 17, CMS issued a press release introducing two free mobile device applications to help physicians and healthcare industry users to track their payments and other financial transfers the industry will report under the OPEN PAYMENTS program (Physician Payments Sunshine Act).

View this press release.
View a related article.

Data show electronic health records empower patients and equip doctors

On July 17, CMS released new data that demonstrate that doctors and hospitals are using electronic health records to provide more information securely to patients and are using that information to help manage their patients’ care.

View this press release

Revisions to Payment Policies under the Physician Fee Schedule, Clinical Laboratory Fee Schedule & Other Revisions to Part B for CY 2014

On July 19, CMS issued a proposed rule addressing changes to the physician fee schedule and other Medicare Part B payment policies to ensure that payment systems are updated to reflect changes in medical practice and the relative value of services, as well as changes in the statute.

View the proposed rule.
View a related fact sheet

OIG issued advisory opinion on proposal to offer GPO members equity interest

On July 23, the OIG released an advisory opinion regarding a proposal to offer members of a group purchasing organization (GPO) an equity interest in the GPO’s parent organization in exchange for the member:

  • Extending its contract with the GPO for five to seven years
  • Committing not to decrease purchasing volume
  • Relinquishing its right to a portion of the administrative fees that would otherwise have been passed through to the members
View the complete notice.

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