Health Information Management

This week's Medicare updates

APCs Insider, October 4, 2013

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Medicare Physician Fee Schedule Database (MPFSDB) 2014 File Layout Manual

On September 20, CMS issued a transmittal to provide the annual file layout for 2013 Medicare Carriers/A/B MACs. This recurring Update Notification applies to Chapter 23, Addendum.

Effective date: January 1, 2014
Implementation date: January 6, 2014

View Transmittal R2790CP.

 

Healthcare Common Procedure Coding System (HCPCS) Annual Update Reminder

On September 20, CMS issued a transmittal updating existing, new, revised, and discontinued alpha-numeric codes for 2014. Contractors must download the file via the CMS mainframe in late October. The Recurring Update Notification applies to Chapter 23, Section 20.

Effective date: January 1, 2014
Implementation date: January 6, 2014

View Transmittal R2791CP.

 

Redaction of Health Insurance Claim Numbers (HICNs) in Medicare Redetermination Notices (MRNs)

On September 25, CMS issued a rescind and replace transmittal to modify business requirement 8268.2 instructing the contractor to not autopopulate the HICNs on reconsideration request forms. All other information remains the same.

Effective date: January 1, 2014
Implementation date: January 6, 2014

View Transmittal R1296OTN.

 

CMS Proposes a Medicare Prospective Payment System for Federally Qualified Health Centers

On September 25, CMS issued a proposed rule to establish a Medicare prospective payment system (PPS) for Federally Qualified Health Centers (FQHCs), as outlined in the Affordable Care Act. The proposed updated payment system, which is scheduled to begin October 1, 2014, would increase Medicare payments to these health centers by approximately 30% for services furnished to Medicare beneficiaries in medically underserved areas.

View the press release
View a related fact sheet
View the proposed rule in the Federal Register
 

Obtaining final Medicare secondary payer conditional payment amounts via web portal

On September 20, a notice was posted to the Federal Register stating that the interim final rule with comment period specifies the process and timeline for expanding CMS’ existing Medicare Secondary Payer (MSP) Web portal to conform to section 201 of the Medicare IVIG and Strengthening Medicare and Repaying Taxpayers Act of 2012 (the SMART Act).

View the report in the Federal Register
 

Application from the compliance team for initial CMS-approval of its rural health clinic accreditation program

On September 20, a notice was posted to the Federal Register acknowledging the receipt of an application from the compliance team for initial recognition as a national accrediting organization for rural health clinics (RHCs) that wish to participate in the Medicare or Medicaid programs.

View the notice
 

Accrediting organization for suppliers of advanced diagnostic imaging supplier accreditation program approved

On September 27, a notice was posted to the Federal Register announcing the approval of RadSite, a national accreditation organization to accredit suppliers seeking to furnish the technical component of advanced diagnostic imaging services under the Medicare program.

View the notice
 

Annual adjustment to the amount in controversy threshold amounts for calendar year 2014 announced

On September 27, a notice was posted to the Federal Register announcing the annual adjustment in the amount in controversy (AIC) threshold amounts for Administrative Law Judge (ALJ) hearings and judicial review under the Medicare appeals process. The adjustment to the AIC threshold amounts will be effective for requests for ALJ hearings and judicial review filed on or after January 1, 2014.

View the notice
 

Medicare incorrectly paid hospitals for beneficiaries who had not received 96 or more hours of mechanical ventilation

On September 17, the OIG issued a report stating that for inpatient claims with certain MS-DRGs, Medicare requires that beneficiaries have received 96 or more hours of mechanical ventilation. For 14 of the 377 claims reviewed, Medicare payments to hospitals were correct. However, for the 363 remaining claims, Medicare payments to hospitals were incorrect.

View the complete report



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