Health Information Management

The week in Medicare updates

APCs Insider, December 13, 2013

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Quarterly update to the Correct Coding Initiative (CCI) edits, Version 20.1, effective April 1, 2014

On November 29, CMS issued a transmittal to update the CCI procedure-to-procedure edits.

Effective date: April 7, 2014

Implementation date: April 7, 2014

View Transmittal R2830CP.
View MLN Matters article MM8511
 

Implementation of permanent CPT code for transcatheter aortic valve replacement (TAVR)

On November 29, CMS issued a transmittal stating it will be retiring HCPCS Category III code 0318T with permanent CPT® code 33366 effective January 1, 2014.

Effective date: January 1, 2014

Implementation date: January 6, 2014

View Transmittal R2827CP.
View MLN Matters article MM8537.
 

Implementation of changes in the End-Stage Renal Disease Prospective Payment System (ESRD PPS) for 2014

On November 29, CMS issued two transmittals implementing the fourth year of the ESRD PPS four-year transition period and the 2014 rate updates for the ESRD PPS.

Effective date: January 1, 2014

Implementation date: January 6, 2014

View Transmittal R2831CP.
View Transmittal R174BP.
View MLN Matters article MM8472
 

State Operations Manual (SOM) Chapter 1 revisions for intermediate care facilities for Individuals with intellectual disabilities (ICF/IID)

On November 29, CMS issued a transmittal stating that revisions have been made throughout Chapter 1 of the SOM to reflect the federally mandated ICF/IID nomenclature. The nomenclature is no longer intermediate care facilities for individuals with mental retardation (ICF/MR).

View Transmittal R93SOMA.
 

Informational unsolicited response (IUR) or reject for ambulance SNF-to-SNF transfer

On November 29, CMS issued a transmittal to include an attachment to the one-time notification.

Effective date: April 1, 2014

Implementation date: April 7, 2014

View Transmittal R1326OTN.
 

Additional updates to Chapter 15 of the Program Integrity Manual (PIM)

On November 29, CMS issued a transmittal to incorporate several recent provider enrollment policy determinations into Publication 100-08, Chapter 15.

Effective date: January 7, 2014

Implementation date: January 7, 2014

View Transmittal R492PI.
View MLN Matters article MM8393.
  

Manual Updates to Clarify SNF, Inpatient Rehabilitation Facility (IRF), Home Health (HH), and Outpatient (OPT) Coverage Pursuant to Jimmo v. Sebelius

On November 29, CMS issued a transmittal stating in accordance with the Jimmo v. Sebelius Settlement Agreement, CMS has agreed to issue revised portions of the relevant chapters of the program manual used by Medicare contractors, in order to clarify coverage of skilled nursing and skilled therapy services.

Effective date: January 7, 2014

Implementation date: January 7, 2014

View Transmittal R175BP.
View MLN Matters article MM8458.
 

Revisions to payment policies under the Physician Fee Schedule (PFS), Clinical Laboratory Fee Schedule (CLFS), and other revisions to Part B for 2014

On December 10, a final rule was posted to the Federal Register regarding revisions to payment policies under the PFS, CLFS, and other revisions to Part B for 2014.

View the final rule
 

Hospital OPPS and Ambulatory Surgical Center Payment Systems and quality reporting programs final rule

On December 10, a final rule was posted to the Federal Register regarding OPPS and Ambulatory Surgical Center Payment Systems, Hospital Value-Based Purchasing Program; Organ Procurement Organizations; Quality Improvement Organizations; Electronic Health Records Incentive Program; and Provider Reimbursement Determinations and Appeals.

View the final rule



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