Health Information Management

The week in Medicare updates

APCs Insider, January 24, 2014

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January 2014 update of the OPPS
On January 14, CMS issued a transmittal describing changes to and billing instructions for various payment policies implemented in the January 2014 OPPS update. Most of these policies are also outlined in the calendar year 2014 OPPS/ASC final rule. The January 2014 I/OCE and OPPS Pricer will reflect the HCPCS APC, HCPCS modifier, and revenue code additions, changes, and deletions identified in this change request.
Effective date: January 1, 2014
Implementation date: January 6, 2014
View Transmittal R2845CP
View MLN Matters article MM8572.
New waived tests
On January 10, CMS issued a transmittal to inform contractors of six new Clinical Laboratory Improvement Amendments waived tests approved by the Food and Drug Administration. Since these tests are marketed immediately after approval, CMS must notify its contractors of the new tests so that the contractors can accurately process claims.  
Effective date: April 1, 2014
Implementation date: April 7, 2014
View Transmittal R2854CP.
View MLN Matters article MM8560.
Changes to the laboratory NCD edit software for April 2014
CMS released a transmittal to announce the changes that will be included in the April 2014 quarterly release of the edit module for clinical diagnostic laboratory services inclusive of ICD-10 translations for NCDs 190.12 through 190.34.
Effective date: April 1, 2014, for ICD-9 only; October 1, 2014, for ICD-10 only
Implementation: April 7, 2014
View Transmittal R2852CP
View MLN Matters article MM8585.
Notice of new interest rate for Medicare overpayments and underpayments
On January 13, 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 Treasury certifies an interest rate quarterly. Treasury utilizes 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 for this transmittal applies to Chapter 3, Section10.
Effective date: January 21, 2014
Implementation date: January 21, 2014
View Transmittal R230FM.
Manual updates to clarify coverage pursuant to Jimmo vs. Sebelius
On January 13, CMS issued a rescind and replace transmittal to correct an error in Chapter 8, Section of the Medicare Benefits Policy Manual. The revisions in Transmittal 176 incorrectly indicated that skilled physical therapy services in the SNF setting must “...require the skills of a qualified therapist (not an assistant) for the performance of a safe and effective maintenance program.” The regulations under 409.32(a) and (b) do not specify that an assistant cannot perform maintenance services in the SNF setting, unlike the home health and outpatient regulations which do make that distinction. Therefore, this updated transmittal corrects that particular language to eliminate the phrase “(not an assistant).” All other information remains the same.
View Transmittal R179BP
OIG report: Medicare payments for vacuum erection systems (VES)
On January 13, the OIG issued a report stating that Medicare payment amounts for VES remain excessive compared with non-Medicare payers.
View the report
OIG report: Medicare claims administration contractors' error rate reduction plans
On January 15, the OIG issued a report stating that according to CMS' Comprehensive Error Rate Testing program. Medicare claims administration contractors improperly paid an estimated $29.6 billion during the fiscal year 2012 reporting period.
View the report.

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