Health Information Management

The week in Medicare updates

APCs Insider, May 29, 2015

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CMS releases July 2015 quarterly Medicare Part B drug pricing files and revisions 
On May 15, CMS released a change request updating the average sales price (ASP) methodology, which is based on quarterly data submitted to CMS by manufacturers. CMS will supply contractors with the ASP and not otherwise classified drug pricing files for Medicare Part B drugs on a quarterly basis. Payment allowance limits under the OPPS are incorporated into the OCE through separate instructions that can be located in Chapter 4 of the Medicare Claims Processing Manual, section 50 of the Internet-Only Manual. 
Effective date: July 1, 2015
Implementation date: July 6, 2015 
View Transmittal R3258CP. 
View MLN Matters article MM9159.
 
CMS releases July 2015 quarterly update to the Medicare Physician Fee Schedule Database
On May 15, CMS released a change request amending payments to payment files issued to contractors based upon the CY 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, 2015, unless otherwise stated
Implementation date: July 6, 2015 
View Transmittal R3259CP. 
View MLN Matters article MM9152.
 
CMS releases Individualized Quality Control Plan workbook 
On May 15, CMS posted a survey and certification letter for the release of a Clinical Laboratory Improvement Amendment workbook, coauthored with the Centers for Disease Control and Prevention.
View the survey and certification letter.
 
CMS updates hospital radiologic and nuclear medicine services interpretive guidelines
On May 15, CMS posted a certification letter for updated interpretive guidelines for the hospital to reflect current accepted standards of practice for radiologic and nuclear medicine services. 
View the survey and certification letter.
 
First Coast Service Options, Inc., paid some unallowable sleep study claims
On May 20, the Office of Inspector General (OIG) posted a report regarding its audit of First Coast Service Options, Inc., the Medicare Administrative Contractor for Jurisdiction 9. First Coast made some payments to providers for sleep study services that were not in accordance with Medicare reimbursement requirements. Of the 100 sampled beneficiaries, First Coast made inappropriate payments to for 61 beneficiaries with 160 corresponding lines of service, resulting in overpayments totaling $68,000. 
View the report.
 
CMS posts tracking sheet for percutaneous left atrial appendage closure therapy 
On May 21, a new tracking sheet was posted regarding the national coverage analysis for percutaneous left atrial appendage closure therapy. 
View the tracking sheet.
 
CMS announces August Advisory Panel on Hospital Outpatient Payment meeting 
On May 22, CMS posted a notice in the Federal Register announcing the summer meeting of the Advisory Panel on Hospital Outpatient Payment for 2015. The purpose of the panel is to advise CMS on the clinical integrity of the APC groups and their associated weights and hospital outpatient therapeutic services supervision issues. The meeting will take place from approximately 9 a.m. (Eastern) to approximately 5 p.m.(Eastern) Monday, August 24, and Tuesday, August 25, . Registration for the meeting will begin Monday, June 29 and end Friday, July 31. 
View the notice in the Federal Register.
 
CGS Administrators, LLC, overpaid providers that incorrectly billed for aflibercept
On May 22, the OIG posted a report stating CGS Administrators, LLC, overpaid providers that incorrectly billed for aflibercept by $1.8 million. CGS made the overpayments because it relied on the providers to confirm that the line items were billed correctly. 
View the report.



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