Health Information Management

The week in Medicare updates

APCs Insider, May 8, 2015

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CMS updates billing instructions for TMVR 
On April 24, CMS rescinded and replaced Transmittal 3142 with billing instructions for transcatheter mitral valve repair (TMVR). Physician providers should note the change related to deleted text concerning billing TMVR for mitral regurgitation with modifier -62 (two surgeons). 
Effective date: August 7, 2014
Implementation date: April 6, 2015 
View Transmittal R3241CP
View MLN Matters article MM9002. 
CMS releases proposed decision memorandum regarding speech generating devices 
On April 29, CMS posted a proposed decision memorandum for speech generating devices at in Chapter 1 of the Medicare National Coverage Determinations Manual. Speech generating devices are covered for patients who suffer from severe speech impairment and have a medical condition warranting the use of a device. CMS is requesting public comments to this proposed decision. 
View the proposed decision memorandum
Leave a comment. 
CMS releases prescriber-level Medicare data for first time 
On April 30, CMS released a new dataset detailing information on the prescription drugs that individual physicians and other healthcare providers prescribed in 2013 under the Medicare Part D Prescription Drug Program. Approximately 68% of all Medicare beneficiaries are enrolled in the program. The dataset describes the specific medications prescribed and statistics on their use and costs. It provides data on more than 1 million distinct healthcare providers who collectively prescribed $103 billion in prescription drugs under the Part D program. The data is posted on the CMS website.
View the fact sheet
View the press release.
CMS opens national coverage analysis for stem cell transplantation  
On April 30, CMS posted a tracking sheet for stem cell transplantation (sickle cell disease and myelofibrosis), opening the national coverage analysis (NCA) for this topic. The initial 30-day public comment period begins with this posting date, and ends after 30 calendar days. CMS considers all public comments, and is particularly interested in clinical studies and other scientific information relevant to the topic under review. 
View the tracking sheet
Leave a comment.
CMS posts technology assessment regarding catheter ablation for treatment of atrial fibrillation 
On April 30, CMS posted a technology assessment to the National Coverage Analysis for catheter ablation for treatment of atrial fibrillation. 
View the technology assessment.
CMS posts technology assessment for use of cardiac resynchronization therapy
On May 1, CMS posted a technology assessment to the cardiac resynchronization coverage determination. 
View the technology assessment.
CMS issues instructions for filing ALJ requests electronically 
On April 30, CMS posted a survey and certification letter stating that, effective October 1, 2014, providers that disagree with actions imposed on their facility and want to request a hearing with an Administrative Law Judge (ALJ) must file a hearing request electronically using the DAB’s E-Filing System (DAB E-File). For assistance in submitting a request through the DAB E-File System, filers may call the Civil Remedies Division main telephone line at 202-565-9462. For technical issues regarding the DAB E-File System, filers may contact E-File System Support at
View the survey and certification letter.

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