Health Information Management

The week in Medicare updates

APCs Insider, March 7, 2014

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Implementation of NACHA operating rules for healthcare electronic funds transfers
On February 21, CMS issued a change request to implement compliance with the National Automated Clearinghouse Association (NACHA) operating rules that were effective September 20, 2013, specifically those that apply to originators of healthcare payments via the Automated Clearing House payment network. 
Effective date: July 1, 2014
Implementation date: July 7, 2014 
View Transmittal R1349OTN.
View relatedMLN Matters® article MM8629.
 
Implementation of HIPAA standards and operating rules
On February 21, CMS issued a change request to ensure Medicare is in compliance with HIPAA administrative simplification requirements. 
Effective date: July 1, 2014
Implementation date: July 7, 2014 
ViewTransmittal R1351OTN. 
 
Aprepitant for chemotherapy-induced emesis
On February 21, CMS extended coverage of the oral antiemetic three-drug regimen of oral aprepitant, an oral 5HT3 antagonist, and oral dexamethasone to beneficiaries who are receiving one or more of 11 anti-cancer chemotherapeutic agents. The change request is effective for claims with dates of service May 29, 2013, and later.
Effective date: May 29, 2013
Implementation date: July 7, 2014. 
View Transmittal R180BP.
View Transmittal R2883CP.  
View relatedMLN Matters article MM8418.
 
Claim status category codes update
CMS is rescinding Transmittal 2858, dated January 17, 2014, and replacing it with Transmittal 2884, dated February 24, 2014, to correct the date when the Claim Status Category and Claim Status Codes approved by the national Code Maintenance Committee will be posted. All other information remains the same. 
Effective date: April 1, 2014
Implementation date: April 7, 2014 
View Transmittal R2884CP. 
View related MLN Matters article MM8582.
 
 
ICD-10 testing with providers
Transmittal 1303, dated November 1, 2013, is being rescinded and replaced by Transmittal 1353, dated February 26, 2014, to provide additional information to providers, suppliers, and clearinghouses about how claims shall be submitted for testing. All other information remains the same. 
Effective date: December 3, 2013
Implementation date: March 3, 2014; November 25, 2013, for Requirement 8465.7 
View Transmittal R1353OTN. 
View related MLN Matters article MM8465.
 
Hospital claimed unallowable Medicare reimbursement for hospital outpatient dental services
Ben Taub General Hospital in Texas claimed Medicare reimbursement for 344 hospital outpatient dental services that did not comply with Medicare requirements. As a result, the OIG concluded that Ben Taub Hospital improperly received $819,000 in Medicare reimbursement for services provided from January 1, 2010, through December 31, 2011. 
View the report.
 
WellSpan York Hospital incorrectly billed Medicare inpatient claims with Kwashiorkor
WellSpan York Hospital in York, Pa., did not comply with Medicare requirements for billing Kwashiorkor—a form of severe protein malnutrition—on any of the 107 claims reviewed by the OIG. The hospital used ICD-9 code 260 for Kwashiorkor but should have used codes for other forms of malnutrition. For 59 inpatient claims, correcting the diagnosis code resulted in no change in the payment. However, for the remaining 48 inpatient claims, the errors resulted in overpayments of $204,000. Hospital officials attributed these errors to a misinterpretation of the coding guidelines for malnutrition. 
View the report.
 
National Coverage Analysis for intensive cardiac rehabilitation program
CMS proposed to expand the Intensive Cardiac Rehabilitation (ICR) program benefit to include the Benson-Henry Institute Cardiac Wellness Program, which meets the ICR program requirements set forth by Congress. CMS is seeking comments on the proposed decision. It will respond to public comments in a final decision memorandum. 
View the proposal.
 
MLN Connects Provider eNews for February 27
CMS released its weekly MLN Connects newsletter.

View the newsletter.
 
Reviewing hospital claims for patient status for admissions on or after October 1, 2013
On February 24, CMS updated its "Reviewing Hospital Claims for Patient Status" document.
View the updated document.
 
Selecting hospital claims for patient status review for admissions on or after October 1, 2013 
On February 24, CMS updated its "Selecting Hospital Claims for Patient Status Reviews" document. 
View the updated document.
 
2-midnight inpatient admission guidelines and patient status reviews for admission on or after October 1, 2013
On February 24, CMS updated its document of frequently asked questions regarding the inpatient admission and medical review criteria provided in the 2014 IPPS Final Rule. 
View the updated document.



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