Health Information Management

The week in Medicare updates

APCs Insider, August 15, 2014

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CMS releases October 2014 OPPS update 
On August 1, CMS released a Recurring Update Notification describing changes to and billing instructions for various payment policies implemented in the October 2014 OPPS update. Several new HCPCS codes were included in the update. 
Effective date: October 1, 2014
Implementation date: October 6, 2014 
View Transmittal R3012CP
View MLN Matters® MM8873.
Part B rebilling edit corrections and instructions 
On August 1, CMS released a change request to modify FISS Part B claim overlap edits related to CMS-1599-F for outpatient TOB 13x and 12x. The transmittal also instructs providers that they may offset the Part B co-payment from the Part A deductible or co-payment the patient may have already paid. 
Effective date: January 1, 2015
Implementation date: January 5, 2015 
View Transmittal R1412OTN
View MLN Matters MM8820.
CMS removes user-controlled effective date to apply therapy caps to CAH claims 
On August 1, CMS released a transmittal regarding the application of therapy caps to outpatient therapy services provided in critical access hospitals (CAHs), which was initially implemented on a time-limited basis. As a result of subsequent rulemaking, this policy is no longer time-limited and is not subject to periodic legislative extensions. This transmittal revised Medicare systems to remove user-controlled effective dates from the process which applies the therapy caps to CAH claims. 
Effective date: January 1, 2015
Implementation date: January 5, 2015
View Transmittal R1411OTN.
OIG finds Part D beneficiaries with questionable utilization patterns for HIV drugs 
On August 6, OIG posted a report detailing Part D beneficiaries with questionable drug utilization patterns. 
View the report.
Summer HOP Panel meeting and agenda now scheduled for one day only 
On August 6, CMS announced the summer 2014 Hospital Outpatient Payment (HOP) Panel meeting and agenda is now scheduled for one day only, Monday, August 25. The public meeting start time is unchanged and it is anticipated the meeting will conclude on Monday no later than approximately 12 p.m.   View the story.
TMVR coverage updated
On August 7, CMS posted a decision memorandum regarding coverage of Transcatheter Mitral Valve Repair (TMVR). TMVR is covered for the treatment of significant symptomatic degenerative mitral regurgitation when furnished according to an FDA-approved indication and other conditions are met. 
View the decision memorandum.

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