Health Information Management

The week in Medicare updates

APCs Insider, May 1, 2015

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Third quarter 2015 notice of new interest rate for Medicare overpayments and underpayments posted
On April 13, CMS released a transmittal regarding the quarterly interest rate for Medicare overpayments and underpayments. Medicare Regulation 42 CFR Section 405.378 provides for the charging and payment of interest on overpayments and underpayments to Medicare providers. Interest is assessed on delinquent debts to protect the Medicare Trust Funds. The recurring update notification applies to Chapter 3 of Medicare Financial Management, section 10. 
Effective date: April 17, 2015
Implementation date: April 17, 2015
View Transmittal R250FM.
 
CMS releases clarification for ordering and certifying documentation maintenance requirements 
On April 17, CMS released a change request to clarify the term "access to documentation" in Chapter 15 of the Medicare Program Integrity, section 15.18.
Effective date: July 20, 2015
Implementation date: July 20, 2015
View Transmittal R587PI. 
View MLN Matters article MM9112.
 
CMS issues update to Remittance Advice Remark and Claims Adjustment Reason codes
On April 17, CMS released a change request to update the Claim Adjustment Reason Code and Remittance Advice Remark Code lists and instructions to update the Medicare Remit Easy Print and PC Print. This recurring update notification applies to Chapter 22 of the Medicare Claims Processing Manual, sections 40.5, 60.1, and 60.2. 
Effective date: July 1, 2015
Implementation date: July 6, 2015 
View Transmittal R3236CP. 
View MLN Matters article MM9125.
 
Government releases guidance for healthcare governing boards on compliance oversight 
On April 20, the Office of Inspector General and other industry leaders released an educational resource regarding compliance oversight for healthcare governing boards. In addition to governing boards of healthcare organizations, the document will also assist internal auditors, lawyers, and compliance officers that report to those boards. This resource highlights the complementary roles of the internal audit, compliance, and legal functions in any comprehensive compliance program. 
View the resource. 
View the story.
 
Wolters Kluwer requests addition of Lexi-Drugs to Medicare compendium
On April 21, CMS posted a notice that Wolters Kluwer requested the formal addition of Lexi-Drugs to the list of compendia used by the Medicare program in the determination of a "medically accepted indication" for off-label drugs and biologics used in an anticancer chemotherapeutic treatment regimen. The public comment period begins the date of this posting and ends after 30 calendar days. CMS considers all public comments and is particularly interested in feedback on the addition of Lexi-Drugs to this list of compendia. 
View the notice. 
View the Anti-Cancer compendia. 
Leave a comment.
 
CMS releases April 2015 OPPS update 
On April 22, CMS released a recurring update notification with changes to and billing instructions for various payment policies implemented in the April 2015 OPPS update. The April 2015 Integrated OCE (I/OCE) and OPPS Pricer will reflect the HCPCS, APC, HCPCS modifier, and Revenue Code additions, changes, and deletions identified in this change request. This recurring update notification applies to Chapter 4 of the Medicare Claims Processing Manual, sections 10.12, 20.6.11, and 180.7. The April 2015 revisions to I/OCE data files, instructions, and specifications are provided in the forthcoming April 2015 I/OCE change request. Transmittal 3235, dated April 14, is being rescinded and replaced by Transmittal 3238 to correct references to the tables. All other information remains the same. 
Effective date: April 1, 2015
Implementation date: April 6, 2015 
View Transmittal R3238CP.
 
CMS says participation continues to rise in Medicare PQRS and Electronic Prescribing Incentive Program 
On April 23, CMS released the 2013 Physician Quality Reporting System (PQRS) and Electronic Prescribing (e-prescribing) Incentive Program Experience Report, which provides data and trends on participation, incentive eligibility, incentive payments, and payment adjustments since the beginning of the programs.
View the fact sheet.
 
CMS posts quarterly listing of program issuances
On April 24, CMS posted a quarterly notice in the Federal Register listing CMS manual instructions, substantive and interpretive regulations, and other Federal Register notices that were published from January through March 2015, relating to the Medicare and Medicaid programs and other programs administered by CMS. 
View the notice in the Federal Register.
 
CMS schedules MEDCAC meeting 
On April 24, CMS posted a notice in the Federal Register announcing a public meeting of the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) will be held at 7:30 a.m. (Eastern) Wednesday, July 22. This meeting will specifically focus on lower extremity peripheral artery disease. This meeting is open to the public. 
View the notice in the Federal Register. 
Register for the event. 
Leave a comment.



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