The week in Medicare updates
APCs Insider, May 30, 2014
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CMS issues change request for lumbar decompression coverage
On May 16, CMS released a change request to assert that effective for claims with dates of service on or after January 9, 2014, percutaneous image-guided lumbar decompression is covered by Medicare when provided in a clinical study under section 1862(a)(1)(E), through Coverage with Evidence Development for beneficiaries with lumbar spinal stenosis.
Effective date: January 9, 2014
Implementation date: October 6, 2014
View Transmittal R2959CP.
View Transmittal R167NCD.
July 2014 I/OCE specifications version 15.2 released
On May 16, CMS released a notification that provides the Integrated OCE instructions and specifications for the Integrated OCE that will be used under the OPPS and non-OPPS for hospital outpatient departments, community mental health centers, and all non-OPPS providers.
Effective date: July 1, 2014
Implementation date: July 7, 2014
View Transmittal R2957CP.
CMS summarizes proposals for solid organ transplant programs
On May 16, CMS posted a survey and certification memorandum summarizing only the proposals related to solid organ transplant programs.
View the survey and certification letter.
EHR 'navigators' may be requested during hospital surveys
On May 16, CMS posted a memorandum to advise hospitals and CAHs that State Survey Agency surveyors may be requesting that experienced hospital/CAH EHR users with appropriate system permissions be assigned as “navigators.”
Navigators would assist surveyors with medical record information retrieval for survey tasks requiring detailed medical record review. This would be similar to the traditional expectation for paper-based records that hospitals and CAHs retrieve requested by surveyors, and hospitals/CAHs are expected to provide the necessary assistance to enable surveyors to review EHRs.
View the survey and certification letter.
OIG regional inspector general delivers testimony about Medicare
On May 20, the OIG’s Regional Inspector General for the Office of Evaluation and Inspections Jodi D. Nudelman delivered a testimony during the hearing “Current Hospital Issues in the Medicare Program.” Nudelman summarized OIG’s work in three areas that are key to improving the Medicare program: hospital observation and short inpatient stays, Recovery Audit Contractors, and the Medicare appeals process.
View the testimony.
OIG acting deputy inspector general delivers testimony about Medicare Mismanagement
On May 20, the OIG’s Acting Deputy Inspector General for Evaluation and Inspections Brian P. Ritchie testified during a hearing titled “Medicare Mismanagement: Oversight of the Federal Government Efforts to Recapture Misspent Funds.” Ritchie testified about recommendations to prevent Medicare improper payments, increase recoveries of overpayments, ensure effective performance by contractors, and improve the Medicare appeals process that resolves disputes over improper payments.
View the testimony.
Contract year 2015 policy and technical changes to the Medicare Advantage and the Medicare prescription drug benefit programs
On May 22, CMS published a final rule in the Federal Register that will revise the Medicare Advantage program (Part C) regulations and prescription drug benefit program (Part D) regulations to implement statutory requirements; improve program efficiencies; and clarify program requirements. The final rule also includes several provisions designed to improve payment accuracy.
View the notice on the Federal Register.
View the fact sheet.
View the press release.
Modifications proposed to the Medicare and Medicaid EHR Incentive Programs for 2014
On May 22, CMS posted a proposed rule that would change the meaningful use stage timeline. It would also change the requirements for the reporting of clinical quality measures for 2014. Comments are due by July 21.
View the notice on the Federal Register.
View the press release.
View the comment docket.
CMS seeks input on prior authorization process for certain durable medical equipment, prosthetics, orthotics and supplies items
On May 22, CMS issued a proposed rule that would build on a successful demonstration program and establish a prior authorization process for certain durable medical equipment, prosthetics, orthotics, and supplies items. Using a prior authorization process will help ensure that these supplies are provided efficiently and consistent with the law. The proposed rule aims to prevent unnecessary utilization while ensuring beneficiaries’ access to medically necessary items.
View the fact sheet.
View the press release.
Prior authorization process for repetitive scheduled non-emergent ambulance transport
On May 22, CMS announced it will begin implementing a prior authorization demonstration program for repetitive scheduled non-emergent ambulance transport in New Jersey, Pennsylvania, and South Carolina. CMS will test whether prior authorization helps reduce expenditures, while maintaining or improving quality of care.
View the fact sheet.
Prior authorization process for non-emergent hyperbaric oxygen therapy
On May 22, CMS announced it will begin implementing a prior authorization demonstration program for non-emergent hyperbaric oxygen therapy in Illinois, Michigan, and New Jersey. CMS will test whether prior authorization helps reduce expenditures, while maintaining or improving quality of care.
View the fact sheet.
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