The week in Medicare updates

CMS releases ICD-10 acknowledgement and end-to-end testing details

On January 5, CMS released a Special Edition MLN Matters article regarding frequently asked questions for physicians, providers, suppliers, clearinghouses, and billing agencies that participate in acknowledgement testing and are selected to participate in Medicare ICD-10 end-to-end testing. These parties should review the following questions and answers before preparing claims for ICD-10 acknowledgement testing and end-to-end testing to gain an understanding of the guidelines and requirements for successful testing. 

View Special Edition MLN Matters article SE1501.

 

CMS and CERT MACs release adequate documentation fact sheet  

On January 5, CMS and the CERT Part A and Part B MAC Outreach & Education Task Force released a fact sheet discussing the importance of submitting adequate documentation to ensure that claims are supported as billed.
View the fact sheet.
 

On January 5, the Office of Inspector General posted Advisory Opinion No. 14-11 on its website. 

See OIG Advisory Opinion No. 14-11.

On January 7, 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 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 Transmittal 3146, dated December 11, 2014, is being rescinded and replaced by Transmittal 3160.

Effective date: January 1, 2015

Implementation date: January 5, 2015 

View Transmittal R3160CP.

On January 7, CMS released a change request to update section 3.2.3.2 of Chapter 3 of the Program Integrity Manual to address the new prepayment review timeframe for additional documentation requests (ADRs) submission and to also instruct the shared systems maintainers to produce ADRs to reflect the new change. Transmittal 554, issued November 14, 2014, is being rescinded and replaced by Transmittal 566, to insert revisions from change request 9012 not included in the original issuance. All other information remains the same. 

Effective date: April 1, 2015

Implementation date: April 6, 2015 

View Transmittal R566PI.

 

On January 8, CMS released a change request for claims with dates of service on and after June 11, 2013, stating CMS will cover three fluorodeoxyglucose (FDG) positron emission tomography (PET) scans when used to guide subsequent management of anti-tumor treatment strategy after completion of initial anti-cancer therapy for the same cancer diagnosis. Local Medicare Administrative Contractors will determine coverage of any additional FDG PET scans (that is, beyond three) used to guide subsequent management of anti-tumor treatment strategy after completion of initial anti-cancer therapy for the same diagnosis. Transmittal 2932, dated April 18, 2014 is being rescinded and replaced by Transmittal 3162 to remove Attachment A to the Medicare Claims Processing Manual and replace it with a web link in section 60.16A of the manual instruction that includes the list of appropriate diagnosis codes. Additionally, a diagnosis code that was inadvertently left off has been included. All other information remains the same. This change request rescinds and fully replaces change request 8468/TR2873 dated February 6, 2014. 

View Transmittal R3162CP.