Health Information Management

This week's Medicare updates

APCs Insider, August 9, 2013

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Health Insurance Portability and Accountability Act (HIPAA) EDI front end updates for January 2014

On August 2, CMS issued a transmittal to provide the January 2014 Common Edits and Enhancements Module (CEM) edits for the A/B Medicare Administrative Contractors (MACs) and the Common Electronic Data Interchange (CEDI) contractor. Additionally, this CR directs Shared Systems to appropriately update the CEM.

Effective date: January 1, 2014

Implementation date: January 6, 2014

View transmittal R1271OTN.

 
Tracking Medicare contractors' postpayment reviews

On August 2, CMS issued a transmittal to instruct the Medicare Administrative Contractors (MACs) to enter claim information on complex reviews into the Recovery Audit Contractor Data Warehouse. This includes information on all claims where an additional documentation request was sent, even if the review did not result in an improper payment.

Effective date: October 3, 2014

Implementation date: October 3, 2014

View transmittal R477PI.

 
Positron Emission Tomography

Effective for dates of service on or after March 7, 2013, local Medicare Administrative Contractors (MACs) may determine coverage within their respective jurisdictions for positron emission tomography (PET) using radiopharmaceuticals for their Food and Drug Administration (FDA) approved labeled indications for oncologic imaging.

Effective date: March 7, 2013

Implementation date: September 3, 2013

View transmittal R2750CP

View transmittal R156NCD.

 

Revisions and deletions to the Internet Only Manual, Publication 100-06, Chapter 3, Overpayment (Section 50.3); Chapter 4, Debt Collection (Section 50 - 50.6 and 100.6.4) Related to Extended Repayment Schedules (ERS)

On August 2, CMS issued a transmittal to include changes to the ERS process that enhances management and procedure efficiency. It also updates policy language and standard practice.

Effective date: September 3, 2013

Implementation date: September 3, 2013

View transmittal R224FM.

 
CEDI Removal of 4010A1 Jobs and Processes

On August 2, CMS issued a transmittal to direct the Common Electronic Data Interchange (CEDI) contractor to remove all jobs and processes associated with accepting and processing the Accredited Standards Committee (ASC) X12 version 4010A1 and the National Council for Prescription Drug Programs (NCPDP) version 5.1 claims. With the transition to ASC X12 version 5010 and NCPDP version D.0 in April 2012, t CEDI and any subcontractors do not need to update and maintain the obsolete formats.

Effective date: October 1, 2013

Implementation date: October 7, 2013

View transmittal R1272OTN.

 

The Supplemental Security Income (SSI)/Medicare Beneficiary Data for Fiscal Year 2011 for Inpatient Prospective Payment System (IPPS) Hospitals, Inpatient Rehabilitation Facilities (IRFs), and Long-Term Care Hospitals (LTCH)

On August 2, CMS issued a transmittal to provide updated data for determining the disproportionate share adjustment for IPPS hospitals and the low income patient adjustment for IRFs. The SSI/Medicare beneficiary data for hospitals are available electronically and contain the name of the hospital, CMS certification number, SSI days, total Medicare days, and the ratio of Medicare Part A patient days attributable to SSI recipients.

Effective date: September 3, 2013

Implementation date: September 3, 2013

View transmittal R1274OTN.

 

Instructions for Downloading the Medicare ZIP Code File for January 2014

On August 2, CMS issued a transmittal describing the process for updating the two Medicare ZIP Code files (ZIP5 and ZIP9) for the January 2014 quarter. This instruction also describes the revision to and the process for downloading the Calendar Year-End ZIP Code files per CR 5881, Transmittal 1463. The attached Recurring Update Notification applies to Chapter 15, Section 20.1.5(B).

Effective date: January 1, 2014

Implementation date: January 6, 2014

View transmittal R2753CP.

 

October Update to the CY 2013 Medicare Physician Fee Schedule Database (MPFSDB)

On August 2, CMS issued a transmittal stating that payment files were issued to contractors based upon the CY2013 Medicare Physician Fee Schedule (MPFS) Final Rule. This change request amends those payment files. This Recurring Update Notification applies to Pub. 100-04, Medicare Claims Processing Manual, Chapter 23, Section 30.1.

Effective date: January 1, 2013, for 'MU00.@BF12390.MPFS.CY13.RV4.C00000.V0830'; October 1, 2013, for 'MU00.@BF12390.MPFS.CY13.RV4.C00000.V0815

Implementation date: October 7, 2013  

View transmittal R2754CP.
 
CMS issues FY 2014 inpatient payment rule

On August 2, CMS issued a final rule updating fiscal year (FY) 2014 Medicare payment policies and rates for inpatient stays at general acute care and long-term care hospitals (LTCHs). The rule improves value and quality in hospital care and provides clarification about when a patient should be admitted to the hospital. It also responds to recent concerns about extended Medicare beneficiary stays in the hospital outpatient department.

View the press release.

View a fact sheet on payment changes

View a fact sheet on improving quality of care.

 

CMS finalizes updates to the wage index and payment rates for the Medicare hospice benefit

On August 2, CMS issued a final rule [CMS-1449-F] that would update fiscal year (FY) 2014 Medicare payment rates and the wage index for hospices serving Medicare beneficiaries.

View a related fact sheet.



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