Health Information Management

The week in Medicare updates

APCs Insider, September 26, 2014

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CMS releases fourth version of related claims transmittal
On September 12, CMS released a fourth version of a transmittal allowing the MACs and Zone Program Integrity Contractors the discretion to deny claims that are "related" and providing approved examples of such situations. Rescinded versions of the transmittal include R534PI, R537PI, and R540PI. R534PI is not currently marked as rescinded even though R540PI indicates it is a replacement, and R537PI is not posted separately but is currently posted as the attachment to R534PI. 
Effective date: September 8, 2014
Implementation date: September 8, 2014 
View Transmittal R541PI.
 
Billing for cost-based payment for CRNA services furnished by OPPS hospitals
On September 12, CMS released a change request to manualize system logic changes previously implemented regarding certified registered nurse anesthetists (CRNA) services.
Effective date: April 1, 2003
Implementation date: December 15, 2014 
View Transmittal R3065CP. 
View MLN Matters article MM8897.
 
Medicare Part B drug payment rates higher than rates paid by other government programs 
On September 16, the Office of Inspector General posted a report stating Medicare Part B would have saved millions of dollars in 2011 if dispensing fees for certain drugs had been aligned with the rates that Part D and state Medicaid programs paid.
Part B paid $132.9 million in dispensing and supplying fees. OIG estimated Part B would have paid dispensing and supplying fees of $22 million, a savings of $110.9 million, if Part B rates had been the same as the average Part D rates. If Part B rates had been the same as the average state Medicaid program rates, Part B would have paid dispensing and supplying fees of $26.6 million, a savings of $106.3 million. 
View the report.
 
CMS says ACOs continue to improve care, lower cost growth 
On September 16, CMS issued quality and financial performance results showing that Medicare Accountable Care Organizations (ACOs) have successfully improved the quality of care for Medicare beneficiaries by fostering greater collaboration between physicians, hospitals, and healthcare providers and keeping patients healthy rather than treating them when they were sick. 
View the fact sheet.
 
CMS updates waived tests transmittal 
On September 17, CMS rescinded and replaced a transmittal on new Clinical Laboratory Improvement Amendments waived tests to correct coding information for one test. 
Effective date: October 1, 2014
Implementation date: October 6, 2014 
View Transmittal R3070CP.
 
CMS issues minor updates to hospital appeals settlement
On September 17, CMS posted small changes to its offer to pay 68% for pending appeal claims to hospitals that withdraw their pending appeals. Updates included small language changes, including a revised administrative agreement, which resolved an issue with the hospital name field being too short for some hospitals. 
View the website. 
Read the transcript or listen to the audio of the MLN Matters call regarding this settlement.
 
Medicare Advantage enrollment at all-time high
On September 18, a press release from CMS announced that more people with Medicare will have access to Medicare Advantage plans, and for the fifth straight year, enrollment is projected to increase to a new all-time high.
View the press release.
 
CMS details August meeting of Advisory Panel on Hospital Outpatient Payment 
CMS uploaded a document detailing the events of the Advisory Panel on Hospital Outpatient Payment meeting that took place in August, including the agenda and recommendations. CMS did not publish information on the recommendations related to supervision of chemotherapy and complex drug administration. Supervision of these services was on the agenda for the meeting and CMS had solicited comments prior to the meeting.  
View the Advisory Panel on Hospital Outpatient Payment website.



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