The week in Medicare updates
APCs Insider, April 18, 2014
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Implementation of NACHA operating rules for healthcare electronic funds transfers
On April 9, CMS issued a change request to implement compliance with NACHA operating rules that took effect on September 20, 2013, specifically those that apply to originators of healthcare payments via the ACH payment network.
Effective date: July 1, 2014
Implementation date: July 7, 2014
Medicare Claims Processing Manualto provide language-only changes for updating ICD-10 and ASC X12
On April 10, CMS issued a change request about language-only changes for updating ICD-10 and ASC X12 language in Pub 100-04, Medicare Claims Processing Manual, Chapter 11. There are no new coverage policies, payment policies, or codes introduced in this transmittal. Also, CMS delete the letter “N” after the X12 in the title for section 110 . This is the only change to the title for section 110.
Effective date: October 1, 2014
Implementation date: October 1, 2014
April 2014 update of the Ambulatory Surgical Center payment system
On April 10, CMS issued a Recurring Update Notification describing changes to and billing instructions for various payment policies implemented in the April 2014 ASC payment system update. This applies to the Medicare Claims Processing Manual chapter 14, section 10. As appropriate, this notification also includes updates to HCPCS.
Effective date: April 1, 2014
Implementation date: April 7, 2014
Clarification of remittance advice code combination reports generated by shared systems
On April 10, CMS issued a change request clarifying the instruction to generate a monthly report to identify code combinations that have been used by MACs outside of the current code combinations list per Operating Rules - Business Requirement 7 in CR 8182. CMS clarified that a quarterly report capturing all (both compliant as well as non-compliant) code combinations in the inventory must also be generated. This quarterly inventory report, essentially has a time period of one day (i.e., January 1, April 1, July 1, and October 1). Those are the days the shared systems should provide a full list of codes that exist in the system. The change request provides specific instructions about the fields that need to be in these reports and how to share the reports with CMS. Two templates have been attached to the change request that will be uploaded by the MACs to http://www.dtasdata.info by the seventh of the following month.
Effective date: July 1, 2014
Implementation date: July 7, 2014 - MCS and VMS (Analysis and Coding); October 6, 2014 - FISS and VMS (Coding, Testing, and Implementation).
View Transmittal R1369OTN.
View Transmittal R1369OTN.
OIG reports questionable billing for Medicare electrodiagnostic tests
On April 7, the OIG issued a report in which it analyzed Medicare 2011 electrodiagnostic test claims to identify physicians who had unusually high billing for at least one of seven measures of questionable billing.
CMS generally met requirements in the Durable Medical Equipment competitive bidding round 1 rebid program
On April 8, the OIG issued a report determining that CMS generally selected durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers and correctly computed the sampled DMEPOS single payment amounts in accordance with its established procedures and applicable Federal requirements.
HHS releases physician-level Medicare data
On April 9, Health and Human Services released a new privacy-protected data set that has information on the number and type of healthcare services that individual physicians and certain other healthcare providers furnished in 2012 under the Medicare Part B fee-for-service (FFS) program, as well as information on the amount that Medicare paid them for those services.
CMS ensures higher value and quality for Medicare health and drug plans
On April 7, CMS issued the 2015 rate announcement and final call letter for Medicare Advantage and prescription drug benefit (Part D) programs.
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