The week in Medicare updates
APCs Insider, September 5, 2014
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CMS clarifies treatment of extracorporeal photopheresis
On August 22, CMS released a transmittal clarifying coverage of extracorporeal photopheresis in hospital inpatient and outpatient departments for the treatment of bronchiolitis obliterans syndrome (BOS) following lung allograft transplantation only when provided under a clinical research study that meets specific requirements. The clarification addresses other coverage of extracorporeal photopheresis for other covered diagnoses, as well as coverage for BOS. CMS indicated there were no new policies provided in the transmittal, but the clarifications were necessary because of inappropriate denials.
Effective date: September 23, 2014; ICD-10: Upon implementation of ICD-10
Implementation date: September 23, 2014
ViewTransmittal R3050CP.
CMS creates new physician specialty code
On August 22, CMS released a change request to create a new physician specialty code for interventional cardiology (C3) and a new non-physician specialty code for restricted use (C4). In addition, the changes were made to the descriptions of existing codes.
Effective date: January 1, 2015
Implementation date: January 5, 2015
View Transmittal R3048CP.
View Transmittal R238FM.
Reporting NPIs on anti-markup and reference laboratory claims
On August 22, CMS released change request to provide guidance for physicians and suppliers billing anti-markup and reference laboratory claims. Physicians and other suppliers will no longer be permitted to submit their own National Provider Identifier (NPI) in Item 32a (or its electronic equivalent) when the performing physician or supplier is located in another jurisdiction. The changes implemented will allow contractors the ability to verify all physician and supplier NPIs, regardless of the jurisdiction in which they are enrolled.
Effective date: January 1, 2015
Implementation date: January 5, 2015 for claims received on or after January 1, 2015
View Transmittal R3047CP.
October update to the 2014 Medicare physician fee schedule database
On August 22, CMS released a transmittal announcing the release of the October update to the Medicare physician fee schedule payment files. An attachment to the file contains changes and corrections implemented in this version of the file.
Effective date: October 1, 2014
Implementation date: October 6, 2014
View Transmittal R3046CP.
CMS releases quarterly update to CCI edits
On August 22, CMS released a transmittal announcing the release of the October quarterly update to the CCI procedure-to-procedure edits.
Effective date: January 1, 2015
Implementation date: January 5, 2015
View Transmittal R3044CP.
Influenza vaccine payment allowances pending for 2014-15 season
On August 22, CMS released a recurring update notification indicating that the payment allowance for the influenza vaccine for the 2014-15 season is still pending. This payment allowance would apply to claims in August 2014.
Effective date: August 1, 2014
Implementation date: November 24, 2014
View Transmittal R3033CP.
CMS announces three ICD-10 acknowledgement testing weeks
On August 22, CMS released a change request to instruct MACs to promote three specific acknowledgement testing weeks with providers, and provide data and statistics to CMS to demonstrate readiness for the ICD-10 transition.
Effective date: 30 days from issuance for provider education, Business Requirement (BR) 2; November 17, 2014, for the November 2014 testing week; March 2, 2015, for the March 2015 testing week; June 1, 2015, for the June 2015 testing week
Implementation date: 30 days from issuance for provider education, BR 2; November 17 through 21, 2014, for the November testing week; March 2 through 6, 2015, for the March testing week; June 1 through 5, 2015, for the June testing week; November 26, 2014, for BR 6, for the November 2014 testing week; March 11, 2015, for BR 6, for the March 2015 testing week; June 10, 2015, for BR 6, for the June 2015 testing week
View Transmittal R1423OTN.
Adjustment to implement NUBC revision to definition for Code 72
On August 25, CMS released a change request to implement the adjustment of a consistency edit to validate claims based on the revised National Uniform Billing Committee (NUBC) definition for Occurrence Span Code (OSC) 72.
Effective date: October 1, 2014
Implementation date: October 6, 2014
View Transmittal R3051CP.
OIG posts new advisory opinion
On August 25, OIG posted an advisory opinion on use of a "preferred hospital" network as part of Medicare Supplemental Health Insurance policies.
View the document.
CMS offering agreement to hospitals willing to withdraw pending appeals in exchange for partial payment
On August 29, CMS announced it will make an agreement with any hospital willing to withdraw their pending claims in exchange for timely partial payment. This agreement is available to acute care and critical access hospitals. Facilities in other categories are not eligible to submit a settlement request.
View the document.
Fingerprint-based background checks instituted
On August 19, CMS released a Special Edition MLN Matters article stating fingerprint-based background checks will be required for all individuals with a 5% or greater ownership interest in a provider or supplier that falls into the high-risk category and is currently enrolled in Medicare or has submitted an initial enrollment application.
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