Health Information Management

The week in Medicare updates

HIM-HIPAA Insider, May 11, 2015

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CMS updates billing instructions for TMVR On April 24, CMS rescinded and replaced Transmittal 3142 with billing instructions for TMVR. Physician providers should note the change related to deleted text concerning billing TMVR for mitral regurgitation with modifier -62.

Effective date: August 7, 2014
Implementation date: April 6, 2015
View Transmittal R3241CP.
View MLN Matters article MM9002.
CMS revises rural health clinic certification
On April 24, CMS released a change request stating provisions in Chapter 2 of the State Operations Manual concerning certification of a rural health clinic are being clarified, and associated Exhibit 26 is being revised accordingly.
Effective date: April 24, 2015
Implementation date: April 24, 2015
View Transmittal R139SOM.
CMS proposes FY 2016 Medicare payment and policy changes for inpatient psychiatric facilities
On April 24, 2015, CMS issued a proposed rule outlining proposed FY 2016 Medicare payment policies and rates for the Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS). The proposed rule also updates the Inpatient Psychiatric Facility Quality Reporting (IPFQR) Program, which requires participating facilities to report on quality measures or incur a reduction in their annual payment update. This proposed rule would expand the measure sets in future fiscal years and change certain data reporting requirements for these measures. Comments are due June 23.
View the proposed rule in the Federal Register.
View the fact sheet.
Leave a comment.
OIG posts Advisory Opinion Number regarding the use of a "preferred hospital"  
On April 29, the OIG posted Advisory Opinion Number 15-05 regarding the use of a "preferred hospital" network as part of Medicare Supplemental Health Insurance ("Medigap") policies. In these cases, the facility requesting guidance would indirectly contract with hospitals for discounts on the otherwise-applicable Medicare inpatient deductibles for its policyholders and, in turn, would provide a premium credit of $100 off the next renewal premium to policyholders who use a network hospital for an inpatient stay.
View the opinion.
CMS releases proposed decision memorandum regarding speech generating devices
On April 29, CMS posted a proposed decision memorandum for speech generating devices at § 50.1 of Chapter 1, part 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.
FY 2016 IPPS proposed rule published in Federal Register
On April 30, the FY 2016 IPPS proposed rule, previously put on display by CMS April 17, appeared in the Federal Register.  
View the notice in the Federal Register.
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 Part D program, 36 million people. The dataset describes the specific medications prescribed and statistics on their utilization and costs. It provides data on more than one million distinct health care providers who collectively prescribed $103 billion in prescription drugs under the Part D program. The new data is posted on the CMS website.
View the fact sheet.
View the press release.
CMS to continue Probe and Educate process for patient status
On April 30, consistent with the Medicare Access and CHIP Reauthorization Act of 2015, CMS posted on its Inpatient Hospital Reviews website that it will continue the Inpatient Probe and Educate process until September 30, 2015 for inpatient hospital status reviews. CMS will also continue to prohibit Recovery Auditors from reviewing these claims for dates of admission occurring between October 1, 2013, and September 30, 2015, as required in the legislation. CMS indicates it believe the Inpatient Probe and Educate process has improved provider understanding of the 2-midnight policy.
View the website.
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 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 NCA for catheter ablation for treatment of atrial fibrillation.
View the technology assessment.
CMS releases 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 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.
$200 million fraud scheme involving corrupt doctors and kickbacks exposed
CNBC's Andrea Day interviews Scott Lampert, Special Agent in Charge in the OIG's New York region. They discuss a $200 million fraud case that involved corrupt physicians sending patients to a blood lab in exchange for illegal kickbacks.
View the video.
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.

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