The week in Medicare updates
HIM-HIPAA Insider, March 24, 2014
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Modifying the Daily Common Working File (CWF) to Medicare Beneficiary Database (MBD) File to Include Diagnosis Codes on the HIPAA Eligibility Transaction System (HETS) 270/271 Transactions
On March 6, CMS issued a change request that instructs the CWF to send up to 25 iterations of diagnosis codes associated with Medicare secondary payer no-fault, liability, and workers' compensation records for inclusion on the HETS 271 response transaction.
On March 6, CMS issued a change request that instructs the CWF to send up to 25 iterations of diagnosis codes associated with Medicare secondary payer no-fault, liability, and workers' compensation records for inclusion on the HETS 271 response transaction.
Effective date: October 1, 2014
Implementation date: October 6, 2014
Update to Pub. 100-01, Chapter 7 for Language-Only Changes for ICD-10
On March 7, CMS issued a transmittal that updates Chapter 7 of the Medicare General Information, Eligibility and Entitlement Manual, Pub 100-01 for language-only changes for ICD-10, and deletes an outdated example in section 40.3.10 that uses ICD-9 codes. Example 1 is deleted and Example 2 is renumbered to become Example 1. There are no changes in procedure.
Supplemental Medical Review Contractor
On March 7, CMS issued a change request to add the Supplemental Medical Review contractor to Chapter 1 of the Medicare Program Integrity Manual, Pub 100-08.
Effective date: April 8, 2014
Implementation date: April 8, 2014
April 2014 Update of the Ambulatory Surgical Center (ASC) Payment System
On March 7, CMS issued a recurring update notification that describes changes to billing instructions for various payment policies implemented in the April 2014 ASC payment system update. The recurring update notification applies to Chapter 14, Section 10. As appropriate, this notification also includes updates to HCPCS.
Effective date: April 1, 2014
Implementation date: April 7, 2014
April 2014 Integrated Outpatient Code Editor (I/OCE) Specifications Version 15.1
On March 7, CMS issued a notification that provides the I/OCE instructions and specifications that will be used under OPPS and non-OPPS. The instructions and specification are 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.
Effective date: April 1, 2014
Implementation date: April 7, 2014
Pub 100-04, Language Only Updates for Conversion to ICD-10
On March 7, CMS issued a change request that contains language-only changes for updating ICD-10 and ASC X12 language in Chapters 5, 6, 10, 13, and 19 of the Medicare Claims Processing Manual, Pub. 100-04. There are no new instructions or changes in procedure.
Indirect Payment Procedure (IPP) - Payment to Entities that Provide Coverage Complementary to Medicare Part B
On March 7, CMS issued a change request to update the manual instructions regarding indirect payment procedure policy (in the Medicare Claims Processing Manual, Pub. 100-04, Chapter 1, Section 30.2.8.3).
Effective date: June 6, 2014
Implementation date: June 6, 2014
ICD-10 Testing with Providers through the Common Edits and Enhancements Module (CEM) and Common Electronic Data Interchange (CEDI)
On March 7, CMS issued a change request to instruct Medicare Administrative Contractors to implement an official ICD-10 Testing Week with trading partners using the CEM and CEDI, and to solicit ideas on how else ICD-10 testing could be accomplished.
Effective date: December 3, 2013
Implementation date: March 3, 2014
State Operations Manual (SOM) Appendix M revisions for Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID)
On March 7, CMS issued a transmittal that outlines revisions for ICF/IID. The State Operations Manual Appendix M-Guidance to Surveyors: Hospice will be revised to reflect the current ICF/IID nomenclature.
Effective date: March 7, 2014
Implementation date: March 7, 2014
April 2014 Update of the Hospital OPPS System
On March 11, CMS issued a recurring update notification that describes changes to and billing instruction for various payment policies implemented in the April 2014 OPPS update. The April 2014 I/OCE and OPPS Pricer will reflect the HCPCS, Ambulatory Payment Classification, HCPCS Modifier, and Revenue Code additions, changes, and deletions identified in this change request.
Effective date: April 1, 2014
Implementation date: April 7, 2014
April Quarterly Update for 2014 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule
On March 11, CMS issued a transmittal stating that Transmittal 2893, dated February 28, 2014, is being rescinded and replaced by Transmittal 2902, dated March 11, 2014. The recurring update notification applies to Chapter 23, section 60 of Pub. 100-04 Medicare Claims Processing Manual.
Effective date: April 1, 2014
Implementation date: April 7, 2014
Reviewing Hospital Claims for Patient Status: Update
On March 12, CMS updated the document “Reviewing Hospital Claims for Patient Status: Admissions On or After October 1, 2013.” All changes and clarifications are in red italics.
Questions and Answers Related to Patient Status Reviews: Update
On March 12, CMS updated the document “Questions and Answers Relating to Patient Status Reviews.” All changes and clarifications are in red italics.
For Information Only: Public Comments on the Report of the National Background Check Program (NBCP) Long-Term Care Criminal Convictions (LTCCC) Work Group
CMS convened a workgroup in response to the Office of Inspector General’s (OIG) recommendation that CMS develop standards to define direct patient access, as well as convictions that should disqualify individuals from direct access employment with LTC facilities and providers. The workgroup also developed standards to define the conviction types that should be considered for mitigation or rehabilitation, and the time period for which each conviction should disqualify individuals from employment.
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