Health Information Management

The week in Medicare updates

APCs Insider, December 20, 2013

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

On December 13, CMS issued a transmittal stating that Transmittal 2800, dated October 25, 2013, is being rescinded and replaced by Transmittal 2834 to insert the final 2014 MEI update and payment rates. All other information remains the same.

Effective date: January 1, 2014

Implementation date: January 6, 2014

View Transmittal R2834CP.  
View MLN Matters article MM8469

Recalcitrant provider

On December 13, CMS issued a transmittal to manualize the formal process for addressing recalcitrant providers and suppliers. CMS has learned from contractors that providers are abusing the program and not changing inappropriate behavior even after extensive education to address these behaviors. These noncompliant providers who refuse to comply with CMS rules, result in contractors placing these providers on prepay medical review for years and utilize resources that would be better utilized for other types of oversight activity.

Effective date: January 15, 2014. This process is currently in effect and this is a clarification through a manual update.

Implementation date: January 15, 2014

View Transmittal R495PI.  
View MLN Matters article MM8394

January 2014 Integrated Outpatient Code Editor (I/OCE) specifications Version 15.0

This notification provides the Integrated OCE instructions and specifications for the Integrated OCE that will be utilized under the OPPS and non-OPPS for hospital outpatient departments, community mental health centers, all non-OPPS providers, and for limited services when provided in a home health agency not under the Home Health Prospective Payment System or to a hospice patient for the treatment of a non-terminal illness. The Recurring Updated Notification applies to 100-04, Chapter 4, section 40.1.

Effective date: January 1, 2014

Implementation date: January 6, 2014

View Transmittal R2838CP.  

Public gets early snapshot of MRSA and Clostridium difficile (C. difficile) infections in individual hospitals

New data posted today and gathered through the Centers for Disease Control and Prevention’s (CDC) National Healthcare Safety Network (NHSN) gives patients a first look at how their local hospitals are doing at preventing C. difficile infections (deadly diarrhea) and methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections.

View a press release

Medicare; Medicare Secondary Payer and certain civil money penalties (CMP)

On December 11, CMS issued an advance notice of proposed rulemaking (ANPRM) solicits public comment on specific practices for which CMPs may or may not be imposed for failure to comply with Medicare Secondary Payer reporting requirements for certain group health and non-group health plans arrangements.

View the notice

Emergency Medical Treatment and Labor Act (EMTALA) requirements and conflicting payer requirements or collection practices

On December 13, CMS issued a survey and certification letter on EMTALA requirements.

View the letter

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