Health Information Management

The week in Medicare updates

APCs Insider, November 1, 2013

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Maintenance and update of temporary hook created to hold OPPS claims that include certain drug HCPCS codes

On October 18, CMS issued a transmittal stating that the “hook” program should be maintained and updated each quarter based on the list of drug HCPCS found at the address provided in Business Requirement 8466.3. This process should continue until further notice. The Recurring Update Notification applies to Chapter 4, Section 50.

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

View Transmittal R2797CP.

 

Notice of new interest rate for Medicare overpayments and underpayments for fiscal year 2014

On October 22, CMS issued a transmittal stating that Medicare Regulation 42 CFR Section 405.378 provides for the charging and payment of interest on overpayments and underpayments to Medicare providers. The Secretary of the Treasury certifies an interest rate quarterly. Treasury uses the most comprehensive data available on consumer interest rates to determine the certified rate. Interest is assessed on delinquent debts in order to protect the Medicare Trust Funds. The Recurring Update Notification applies to Chapter 3, Section 10.

Effective date: October 18, 2013
Implementation date: October 18, 2013

View Transmittal R229FM.

 
Influenza resources for healthcare professionals

On October 22, CMS issued an MLN® Matters Special Edition article reminding healthcare professionals of the various resources they can access regarding influenza virus vaccine for healthcare professionals and patients.

View MLN Matters Special Edition article SE1336.

 

Announcement of Medicare Rural Health Clinic (RHC) and Federally Qualified Health Centers (FQHC) payment rate increases

On October 25, CMS issued a transmittal providing instructions for the calendar year 2013 Payment Rate Increases for RHC and FQHC services that can be found in Chapter 9, Section 20 of the Internet-Only Manual.

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

View Transmittal R2800CP.

 

2014 annual update of HCPCS codes for Skilled Nursing Facility (SNF) Consolidated Billing (CB) update

On October 25, CMS issued a transmittal stating that changes to HCPCS codes and Medicare Physician Fee Schedule designations will be used to revise Common Working File edits to allow A/B MACs, carriers, and FIs to make appropriate payments in accordance with policy for SNF CB in Chapter 6, Section 110.4.1 for carriers/B MACs and Chapter 6, Section 20.6 for FIs/A/B MACs.

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

View Transmittal R2802CP.

 

Instructions for retrieving the 2014 pricing and HCPCS data files through CMS' mainframe telecommunications system

On October 25, CMS issued a transmittal provides the annual update to the various pricing files used by FIs/MACs to adjudicate Part B fee schedule paid claims. The Recurring Update Notification applies to Chapter 23, Section 40.

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

View Transmittal R2801CP.

 

Annual Medicare Physician Fee Schedule (MPFS) files delivery and implementation

On October 25, CMS issued a transmittal to give direction of the notification and implementation of the annual Medicare Physician Fee Schedule files. The Recurring Update Notification applies to Chapter 1, Section 30.3.12.1.2.

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

View Transmittal R2799CP.

 

Post-acute transfer processing of CWF A/B crossover edit 7272 update

On October 25, CMS issued an MLN® Matters Special Edition article with updated editing requirements within the Common Working File system, for which Medicare systems had edits that fired incorrectly in the past. Ensure billing staff are aware of these changes.

View MLN Matters Special Edition article SE1335.

 

CMS issues new patient safety standards for community mental health centers (CMHC)

On October 28, the CMS announced a final rule (CMS 3202-F) establishing a formal set of CMHC conditions of participation, which are the health and safety regulations Medicare providers must meet to participate in the Medicare program.

View the final rule

View a related fact sheet

 
CMS announces major savings for Medicare beneficiaries

On October 28, CMS issued a press release stating that healthcare reform efforts are eliciting significant out-of-pocket savings for Medicare beneficiaries, pointing to zero growth in 2014 Medicare Part B premiums and deductibles, and more than $8 billion in cumulative savings in the prescription drug coverage gap known as the “donut hole.”

View the press release



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