Health Information Management

The week in Medicare updates

HIM-HIPAA Insider, May 12, 2014

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CMS releases July 2014 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files

On April 25, CMS released a transmittal about ASP methodology, which is based on quarterly data submitted to CMS by manufacturers. CMS will supply contractors with the ASP and not otherwise classified (NOC) drug pricing files for Medicare Part B drugs on a quarterly basis. Payment allowance limits under the OPPS are incorporated into the Outpatient Code Editor through separate instructions that can be located in Chapter 4, section 50 of the Internet-Only Manuals.
Effective date: July 1, 2014
Implementation date: July 7, 2014
View Transmittal R2936CP.
View MLN Matters article MM8748.
New to State Operations Manual (SOM) Chapter 10
On April 25, CMS announced that it developed a new SOM Chapter 10 to guide State Agencies and Regional Offices on imposing the alternative sanctions for home health agencies with condition-level deficiencies, which was codified in a final rule in 2012.
Effective date: April 25, 2014
Implementation date: April 25, 2014
View Transmittal R114SOMA.
OIG releases a report on payment and oversight of compounded drugs under Medicare Part B
OIG released a report that indicates neither CMS nor Medicare Administrative Contractors (MAC) tracked the number of claims for compounded drugs under Part B or the corresponding amounts paid, and that Part B claims do not contain information that can be used to systematically identify claims for compounded drugs. OIG also found that claims for compounded drugs do not identify the compounding pharmacy; however, this information may be included in documentation kept by the provider. Finally, OIG found that most MACs manually reviewed Part B claims containing “not otherwise classified” codes, which can represent compounded drugs, to determine payment amounts.
View the report.
OIG Deputy Inspector General delivers testimony at a hearing titled ”Ideas to Improve Medicare Oversight To Reduce Waste, Fraud, and Abuse”
On April 30, Gloria L. Jarmon, deputy inspector general for audit services at the OIG gave a testimony at a hearing on improving Medicare oversight to reduce waste, fraud, and abuse. Jarmon expanded upon the idea that more action is needed from CMS, its contractors, and the Department to reduce improper Medicare payments and billings and improve oversight of its Medicare contractors. Reducing improper payments and improving the oversight of contractors are two of the top management and performance challenges and are critical to reducing waste, fraud, and abuse.
View the testimony.
CMS releases FY2015 IPPS/LTCH-PPS proposed rule
On April 30, CMS released the FY2015 IPPS/LTCH-PPS proposed rule, which focused on proposed changes to focuses on quality measures, such as the hospital-acquired condition reduction, readmissions reduction, and hospital value-based purchasing programs.
View the rule in the Federal Register.
View the press release.
View the related fact sheet.
Proposed FY2015 payment and policy changes for Medicare inpatient rehabilitation facilities
On May 1, CMS issued a proposed rule outlining proposed fiscal year (FY) 2015 Medicare payment policies and rates for inpatient rehabilitation facilities (IRF) and the IRF Quality Reporting Program.
View the fact sheet.
Proposed Medicare payment and policy changes for inpatient psychiatric facilities
On May 1, CMS issued the Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) proposed rule for FY2015. In this proposed rule, estimated payments to IPFs are projected to increase by 2.1% compared to FY2014. The proposed rule also updates the IPF Quality Reporting Program, which requires participating facilities to report on quality measures or incur a reduction in their annual payment update.
View the fact sheet.
View the document.
Changes to federally qualified health centers (FQHC), rural health clinics (RHC), and Clinical Laboratory Improvement Amendments
On May 2, CMS released a final rule with comment period to implement methodology and payment rates for a prospective payment system for FQHC services under Medicare Part B beginning on October 1, 2014, in compliance with the Affordable Care Act. In addition, it establishes a policy that allows RHCs to contract with non-physician practitioners when statutory requirements for employment of nurse practitioners and physician assistants are met. It also implements changes to the Clinical Laboratory Improvement Amendments regulations regarding enforcement actions for proficiency testing referrals.
View the document.
Hospital Inpatient Prospective Payment System for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2015 Rates
CMS is proposing to revise the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals.
View the proposed rule.

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