Health Information Management

The week in Medicare updates

APCs Insider, February 21, 2014

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Medicare Claims Processing Pub. 100-04 Chapter 25 update
On February 6, CMS issued a transmittal to publish an update to the Medicare Claims Processing Manual, Pub. 100-04 Chapter 25, to reflect general manual changes.
Effective date: March 7, 2014
Implementation date: March 7, 2014

View Transmittal R2874CP
 
Fluorodeoxyglucose (FDG) positron emission tomography (PET) for solid tumors
On February 6, CMS issued a change request effective for claims with dates of service on and after June 11, 2013. CMS shall cover three FDG PET scans when used to guide subsequent management of anti-tumor treatment strategy after completion of initial anti-cancer therapy for the same cancer diagnosis. 
Effective date: June 11, 2013
Implementation date: March 7, 2014, for non-shared system edits; July 7, 2014, for shared system edits 
View Transmittal R2873CP.  
Viewrelated MLN Matters® article MM8468.
 
National Coverage Determination (NCD) for single chamber and dual chamber permanent cardiac pacemakers
On February 6, CMS issued a transmittal stating that for claims with dates of service on or after August 13, 2013, contractors shall allow payment for nationally covered implanted permanent cardiac pacemakers, single chamber or dual chamber. 
Effective date: August 13, 2013
Implementation date: July 7, 2014
 
View Transmittal R2872CP.
 
Viewrelated MLN Matters article MM8525.
 
Medicare NCD for Beta Amyloid PET in dementia and neurodegenerative disease
On February 6, CMS issued a transmittal stating that for claims with dates of service on or after September 27, 2013, Medicare will only allow coverage for PET Aβ imaging (one PET Aβ scan per patient) through coverage with evidence development (CED) to:
1. Develop better treatments or prevention strategies for AD, or, as a strategy to identify subpopulations at risk for developing AD, or
2. Resolve clinically difficult differential diagnoses (e.g., front temporal dementia versus AD) where the use of PET Aβ imaging appears to improve health outcomes, when the patient is enrolled in an approved clinical study under CED. 
Effective date: September 27, 2013
Implementation date: July 7, 2014 
View Transmittal R2871CP. 
Viewrelated MLN Matters article MM8526.
 
Reporting principal and interest amounts when refunding previously recouped money on the Remittance Advice
On February 6, CMS issued a transmittal that instructs the shared system maintainers and contractors on how to report the principal and interest separately and also provide individual claim information. 
Effective date: July 1, 2014
Implementation date: July 7, 2014 
View Transmittal R1342OTN. 
Viewrelated MLN MM8485.
 
Update to Pub 100-04, Claims Processing Manual, Chapter One
On February 6, CMS issued a transmittal that removes Sections 20.3, 20.5, and 20.5.1 from Chapter One of Pub 100-04, The Medicare Claims Processing Manual. The sections were removed because they contain policy based on the legacy environment when chains and individual providers were permitted to select the fiscal intermediary of their choice. 
Effective date: March 7, 2014
Implementation date: March 7, 2014
 View Transmittal R2876C. 
View related MLN Matters article MM8842.
 
Fee-for-service beneficiary data streamlining (FFS BDS)
On February 7, CMS issued a transmittal for the shared system maintainers to perform detail analysis, for Phase II of the BDS into the FFS claims processing environment. 
Effective date: July 1, 2014
Implementation date: July 7, 2014 
View Transmittal R1344OTN.
 
National Coverage Analysis (NCA) for lung cancer screening with low-dose computed tomography
The original consideration for lung cancer screening with low-dose computed tomography was posted. 
View the tracking sheet. 
 
Changing Fiscal Intermediary Shared System action on informational unsolicited responses (IURs)
On February 6, CMS issued a change request stating that phase one will require the IURs for incarcerated beneficiaries and unlawful presence-aliens to be processed as adjustments rather than cancels. A future change request will be issued for phase two that will require the remaining IURs that are performed as cancels be changed to adjustments. 
Effective date: July 1, 2014
Implementation date: July 7, 2014
 
View CR8554.
 
 
Modifying the Daily Common Working File (CWF) to the Medicare Beneficiary Database (MBD) file to include diagnosis codes
On February 5, CMS issued a change request that instructs the CWF to send up to 25 iterations of diagnosis codes associated with MSP no-fault, liability, and workers' compensation records for inclusion on the HETS 271 response transaction. 
Effective date: July 1, 2014
Implementation date: July 7, 2014 
View Transmittal R1336OTN.  
View related MLN Matters article MM8554.
 
Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131
On February 14, CMS issued a transmittal that provides removal of language that was erroneously included in the September 6, 2013 issuance of CR 8404, Transmittal 2782, Sections 50.3 and 50.6.2 of Chapter 30 in the Medicare Claims Processing Manual. It also provides revised and clarified manual instructions in Section 50.15.4 regarding home health agency issuance of the (ABN) to dual-eligible beneficiaries. 
Effective date: May 15, 2014
Implementation date: May 15, 2014 
View Transmittal R2878CP.
 
Removing contractor prohibition
On February 5, CMS issued a change request that allows the contractors to make a decision or take action on claims that are not currently being under review.
Effective date: March 6, 2014
Implementation date: March 6, 2014
 
View Transmittal R505PI.  
View related MLN Matters article MM8425.
 



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