The week in Medicare updates
HIM-HIPAA Insider, December 22, 2014
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Implementation of changes in the ESRD PPS for Calendar Year (CY) 2015
On December 2, CMS released a change request implementing the CY 2015 rate updates for the end-stage renal disease (ESRD) PPS. This recurring update notification applies to Medicare Benefit Policy Manual, Chapter 11, section 50. Transmittal 199, dated November 14, 2014, is rescinded and replaced by Transmittal 200 to insert the publication number for each business requirement. All other information remains the same.
Effective date: January 1, 2015
Implementation date: January 5, 2015
View Transmittal R200BP.
Claim Status and Claim Status Category Codes update
On December 5, CMS released a change request to update the Claim Status and Claim Status Category Codes for use by Medicare contractors with the Health Care Claim Status Request and Response ASC X12 276/277 and Health Care Claim Acknowledgment ASC X12 277, which is done three times a year. The committee has decided to allow the industry six months for implementation of newly added or changed codes. Contractors are to use codes posted at http://www.wpc-edi.com/codes on or about February 1, 2015, which are listed as current codes on that site. This Recurring Update Notification (RUN) can be found in Medicare Claims Processing Manual, Chapter 31, Section 20.7.
Effective date: April 1, 2015
Implementation date: April 6, 2015
Medicare Shared Savings Program: Accountable Care Organizations (ACO)
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 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.
OPPS drugs and biologicals with quarterly change request restated payment rates
On December 9, CMS posted a notice on its Hospital Outpatient website stating some drugs and biologicals, based on ASP methodology, may have payment rates that are corrected retroactively. 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 a 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 three page 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 CY 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 H.R.4067 now extends this enforcement instruction through December 31, 2014.
View the document.
Home health prospective payment system (HH PPS) rate update for CY 2015
On December 9, CMS released a change request updating the 60-day national episode rates, the national per-visit amounts, LUPA add-on amounts, and the non-routine medical supply payment amounts under the HH PPS for CY 2015. The attached Recurring Update Notification applies to Pub. 100-04, Medicare Claims Processing Manual, Chapter 10, section 70.5.
Effective date: January 1, 2015
Implementation date: January 5, 2015
View Transmittal R3145CP.
Fiscal 2014 report to Congress outlines achievements
America's taxpayers are expected to see $4.9 billion in improperly spent federal health care dollars returned to the government from oversight and investigations conducted this year by the OIG, according to a report.
View the press release.
Fall 2014 semiannual report to Congress
On December 10, 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.
Timeline for the DMEPOS Competitive Bidding Round 2 recompete and the national mail-order recompete
On December 11, CMS announced the bidding timeline for the Round 2 recompete and the national mail-order recompete of the Medicare DMEPOS Competitive Bidding Program, as required by law. CMS has also launched a comprehensive bidder education program. This program is designed to ensure that DMEPOS suppliers interested in bidding receive the information and assistance they need to submit complete bids in a timely manner.
View the fact sheet.
View the press release.
Home health compare star ratings
On December 11, CMS posted a fact sheet about star ratings for home health agencies, a quality measure used to summarize performance and identify areas for improvement.
View the fact sheet.
Preventive and screening services update released
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 Database, the payments for CY 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. Transmittal 3094, dated October 10, 2014, is being rescinded and replaced by Transmittal 3146 to replace, delete, and add various codes and requirements. Language in Background and Policy has been revised for clarity. Additionally, this change request is no longer sensitive/controversial. All other information remains the same.
Effective date: January 1, 2015
Implementation date: January 5, 2015
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