Health Information Management

The week in Medicare updates

APCs Insider, October 17, 2014

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CMS releases 2015 annual update for HPSA bonus payments 
On October 3, CMS released a change request providing files for the automated payments of Health Professional Shortage Area (HPSA) bonuses for dates of service from January 1, 2015, through December 31, 2015. This Recurring Update Notification applies to Chapter 4, Section 250.2 and Chapter 12, Section 90.4.2 of the Medicare Claims Processing Manual
Effective date: January 1, 2015
Implementation date: January 5, 2015 
View Transmittal R3087CP
View MLN Matters article MM8942.
CMS expands intensive cardiac rehabilitation  
On October 3, CMS released a change request in which Medicare determined there is sufficient evidence to expand the intensive cardiac rehabilitation benefit to include the Benson-Henry Institute Cardiac Wellness Program. This change request is effective for dates of service on and after May 6, 2014. CMS also released a related revision to the Medicare National Coverage Determinations Manual. An NCD that expands coverage is binding on a Medicare advantage organization. In addition, an administrative law judge may not review an NCD. 
Effective date: May 6, 2014
Implementation date: November 4, 2014 
View Transmittal R3084CP
View Transmittal R175NCD.
Medicare beneficiaries paid nearly half of the costs for outpatient services at CAHs
On October 8, the Office of Inspector General posted a report regarding critical access hospital (CAH) payments. Medicare reimburses CAHs at 101% of their "reasonable costs," rather than the predetermined rates set by OPPS. The system Medicare uses to calculate outpatient coinsurance amounts for beneficiaries who receive services at CAHs differs from that used for beneficiaries who receive services at acute care hospitals. Beneficiaries who receive services at CAHs pay coinsurance amounts based on CAH charges, whereas beneficiaries who receive services at acute care hospitals pay coinsurance amounts based on OPPS rates. CAH charges are typically higher than the reasonable costs associated with CAH services or the OPPS rates at acute care hospitals. 
View the report.
CMS updates information regarding hospital appeals settlement offer 
On October 8, CMS updated the information available regarding the hospital appeals settlement offer. The change is regarding proper completion of the Eligible Claims Spreadsheet. 
View the update.
CMS issues final decision on screening for colorectal cancer stool DNA testing 
On October 9, CMS posted a final decision memorandum stating the evidence is sufficient to cover CologuardTM –a multitarget stool DNA test–as a colorectal cancer screening test for asymptomatic, average risk beneficiaries, aged 50 to 85 years.  
View the final decision memorandum
CMS posts Part B monthly actuarial rates, premium rate, and annual deductibles 
On October 10, CMS posted a notice in the Federal Register announcing the monthly actuarial rates for aged (age 65 and over) and disabled (under age 65) beneficiaries enrolled in Part B of the Medicare Supplementary Medical Insurance program beginning January 1, 2015. In addition, this notice announces the monthly premium for aged and disabled beneficiaries as well as the income-related monthly adjustment amounts to be paid by beneficiaries with gross income above certain threshold amounts. 
View the notice on the Federal Register.

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