Health Information Management

The week in Medicare updates

APCs Insider, December 6, 2013

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CMS makes outpatient facility policy and payment changes

On November 27, CMS released a final CY 2014 hospital outpatient and ambulatory surgical center (ASC) payment rule [CMS-1601-FC] that will give hospitals and ASCs new flexibility to lower outpatient facility costs and strengthen the long-term financial stability of Medicare.

View a press release

View a related fact sheet. 


CMS finalizes physician payment rates for 2014

On November 27, CMS finalized physician payment rates and policies for 2014, including a major proposal to support care management outside the routine office interaction as well as other policies to promote high quality care and efficiency in Medicare.

View a press release

View a related fact sheet

View a fact sheet on changes to quality programs and the value-based modifier


Removal of existing material in chapter 14 of the Program Integrity Manual

On November 22, CMS issued a change request to delete the existing material in chapter 14 of CMS Pub. 100-08 (the Program Integrity Manual, or PIM). This material, which deals with National Provider Identifier policy, is either outdated, moot, or has been (or is in the process of being) duplicated in chapter 15.

Effective date: December 24, 2013

Implementation date: December 24, 2013

View Transmittal R491PI. 

2014 annual update for Clinical Laboratory Fee Schedule and laboratory services subject to reasonable charge payment

On November 22, CMS issued a Recurring Update Notification (RUN) providing instructions for the 2014 clinical laboratory fee schedule, mapping for new codes for clinical laboratory tests, and updates for laboratory costs subject to the reasonable charge payment. This Recurring Update Notification applies to chapter 16, section 20.

Effective date: January 1, 2014

Implementation date: January 6, 2014

View Transmittal R2823CP.
View MLN Matters article MM8517.

New Influenza virus vaccine code

On November 22, CMS issued a transmittal to provide instructions for payment and Common Working File edits to be updated to include influenza virus vaccine code 90673 for claims with of service on or after January 1, 2014, processed on or after April 7, 2014. This CR also removes vaccine code 90658, vaccine administration codes G9141 and G9142, and temporary vaccine codes Q2034, Q2035, Q2036, Q2037, Q2038, and Q2039 from chapter 18 sections 1.2, 10.2.1, 10.4.1, 10.4.2, and 10.4.3. In addition, this CR corrects the effective date of code Q2033 from January 1, 2013, to July 1, 2013.

Effective date: July 1, 2013, for code Q2033; January 1, 2014, for code 90673

Implementation date: April 7, 2014

View Transmittal R2824CP.
View MLN Matters article MM8473.

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