The week in Medicare updates
APCs Insider, July 18, 2014
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CMS converting most MUEs to per-day edits
On June 30, CMS released MLN Matters® SE1422, stating that claims filed using noncompliant coding for bilateral surgical procedures may have been paid in the past. The purpose of this article is to inform providers that MUE changes may now render those claim lines unpayable. CMS is converting most MUEs into per-day edits and the MUE Adjudication Indicator indicates the type of MUE and its basis. Effective with the July 1 update, published per-day edits are identified on the CMS NCCI website.
View MLN Matters SE1422.
MACs to post review issues online
On July 3, CMS issued a change request to require MACs to post review issues to their websites. It also requires that the Supplemental Medical Review Contractor maintain a public website that displays what types of issues are under review.
Effective date: September 5, 2014
Implementation date: September 5, 2014
View Transmittal R527PI.
CMS proposes changes for the physician value-based payment modifier
On July 3, CMS issued a proposed rule that would update payment policies and payment rates for services furnished under the Medicare Physician Fee Schedule (MPFS) on or after January 1, 2015. The proposed rule includes proposals for implementing the value-based payment modifier (Value Modifier) required by the Affordable Care Act, which would adjust payments to physicians, groups of physicians, and other eligible professionals based on the quality and cost of care they furnish to beneficiaries enrolled in the traditional FFS program.
View the fact sheet.
CMS clarifies fire safety requirements for rehabilitation agencies
On July 3, CMS released an interpretive guidance revision to clarify the fire safety requirements. Rehabilitation agencies are required to have an automatic extinguishing system or an enclosure with a one-hour fire resistance rating in hazardous areas as well as fire extinguishers, a fire alarm system, and a fire evacuation plan. Air horns will not serve in place of a fire alarm system for rehabilitation agencies. Rehabilitation agencies cannot be certified or recertified and extension locations cannot be approved if they do not meet the minimum fire protection requirements.
View the survey and certification letter.
Medicare signature requirements clarified
On July 7, CMS released MLN Matters SE1419 stating that Medicare requires services provided/ordered be authenticated by the author. The method used should be a handwritten or electronic signature. Under certain circumstances, a rubber stamped signature is acceptable. Without an acceptable signature on services provided/ordered, Medicare payment may be affected.
View MLN Matters SE1419.
OIG finds questionable billing for Medicare Part B clinical laboratory services
On July 8, OIG posted a report regarding a study on billing for clinical laboratory services. In 2010, more than 1,000 labs exceeded the thresholds (i.e., had unusually high billing) for five or more measures of questionable billing for Medicare lab services.
View the report.
CMS proposes updates to ESRD PPS, quality incentive program, and DMEPOS fee schedule
On July 11, CMS posted a proposed rule in the Federal Register that would update and make revisions to the End-Stage Renal Disease (ESRD) PPS for CY 2015. It also proposes to set forth requirements for the ESRD quality incentive program, including payment years 2017 and 2018. This rule also proposes a technical correction to remove outdated terms and definitions. It also proposes changes to the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies DMEPOS fee schedule payment amounts and regulations. Comments are due September 2.
View the notice in the Federal Register.
Revisions to payment policies under Medicare Part B for 2015
On July 11, CMS posted revisions to address changes to the physician fee schedule and other Medicare Part B payment policies to ensure its payment systems are updated to reflect changes in medical practice and the relative value of services, as well as changes in the statute. See the Table of Contents for a listing of the specific issues addressed in this proposed rule. Comments are due September 2.
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