Health Information Management

The week in Medicare updates

APCs Insider, December 19, 2014

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CMS proposes changes for Accountable Care Organizations
On December 8, CMS posted a proposed rule in the Federal Register addressing changes to the Medicare Shared Savings Program, including provisions relating to the payment of Accountable Care Organizations (ACOs) participating in the Shared Savings Program. Under the Shared Savings Program, providers of services and suppliers that participate in an ACO continue to receive traditional Medicare fee-for-service payments under Parts A and B, but the ACO may be eligible to receive a shared savings payment if it meets specified quality and savings requirements. Comments are due by February 6, 2015. 
View the notice in the Federal Register.
Leave a comment.
CMS updates drugs and biologicals with retroactive payment rate updates
On December 9, CMS posted a notice on its hospital outpatient website stating that it may retroactively correct payment rates for some drugs and biologicals, based on ASP methodology. These retroactive corrections typically occur on a quarterly basis as a part of the OPPS payment system quarterly update change request. Beginning with the January 2015 OPPS payment system quarterly update change request, the list of drugs and biologicals with corrected payments rates, for a particular quarter, are accessible from the left menu link titled "Change Request Restated Drug and Biological Payment Rates."
View the Hospital Outpatient website.
Hospital outpatient therapeutic services evaluated for change in supervision level 
On December 9, CMS posted a document on its Advisory Panel on Hospital Outpatient Payment website regarding hospital outpatient therapeutic services evaluated for a change in supervision level. The document contains a chart demonstrating the evaluation and effective dates of changes in supervision level for various services. 
View the document.
Congress extends enforcement instruction on supervision requirements for outpatient therapeutic services in critical access hospitals and small rural hospitals for 2014 
Beginning in 2010, CMS instructed its contractors not to enforce the supervision requirements for therapeutic services provided to outpatients in critical access hospitals and further expanded the non-enforcement to small rural hospitals in 2011. The non-enforcement instruction expired for the hospitals on January 1, 2014. CMS has posted a notice that extends this enforcement instruction through December 31, 2014. 
View the document.
Nearly $5 billion returned to government through healthcare investigations
American taxpayers are expected to see $4.9 billion in improperly spent federal healthcare dollars returned to the government from oversight and investigations conducted this year, according to a report issued today. 
View the press release.
OIG issues semiannual report to Congress 
On December 10, the Office of Inspector General (OIG) released its fall edition of the Semiannual Report to Congress, covering OIG activities from April 2014 through September 2014 and summarizes a full year's achievements. Historically, approximately 80% of OIG's resources are directed to work related to Medicare and Medicaid. This is mirrored in the organization and content of the report. 
View the report.
CMS releases change request related to screening services payments
On December 11, CMS released a change request to ensure accurate program payment for three screening services for which the beneficiary should not be charged the coinsurance or deductible. The coinsurance and deductible for these services are currently waived, but due to coding changes and additions to the Medicare Physician Fee Schedule, the payments for 2015 would not be accurate without this change request for intensive behavioral group therapy for obesity, digital breast tomosynthesis, and anesthesia associated with colorectal cancer screening tests.
Effective date: January 1, 2015
Implementation date: January 5, 2015 
View Transmittal R3146CP.

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