The week in Medicare updates
APCs Insider, March 13, 2015
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CMS releases overview of Physician Feedback and Value-Based Modifier Programs
On February 27, CMS released a special edition MLN Matters article providing an overview of the Physician Feedback and Value-Based Modifier Program. Under the Value-Based Modifier Program, performance on quality and cost measures can translate into payment incentives for providers who provide high quality, efficient care, while providers who underperform may be subject to a downward adjustment.
View special edition MLN Matters article SE1507.
CMS issues April 2015 quarterly update to the Medicare Physician Fee Schedule Database
On February 27, CMS released a change request amending payment files issued to contractors based on the 2015 Medicare Physician Fee Schedule final rule. This recurring update notification applies to the Medicare Claims Processing Manual, Chapter 23, section 30.1.
Effective date: January 1, 2015 for dates of service on or after January 1 unless otherwise stated
Implementation date: April 6, 2015
View Transmittal R3205CP.
CMS adds 30 Clinical Laboratory Improvement Amendment waived tests
On February 27, CMS released a change request to inform contractors of 30 new Clinical Laboratory Improvement Amendments waived tests approved by the FDA. Since these tests are marketed immediately after approval, CMS must notify its contractors of the new tests so that the contractors can accurately process claims.
Effective date: April 1, 2015
Implementation date: April 6, 2015
View Transmittal R3207CP.
OIG posts advisory opinion regarding Medigap proposal
On March 2, OIG posted an advisory opinion regarding the proposed use of a “preferred hospital” network as part of Medicare Supplemental Health Insurance (Medigap) policies.
View the opinion.
CMS incorporates provider enrollment policies into the Program Integrity Manual
On March 4, CMS released a change request to incorporate provisions in CMS-6045-F into Chapter 15 of the Program Integrity Manual. The change request also addresses several minor provider enrollment policy issues.
Effective date: May 28, 2015
Implementation date: May 28, 2015
View Transmittal R582PI.
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