Health Information Management

The week in Medicare updates

APCs Insider, August 7, 2015

Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

CMS revises signature requirements
On July 24, CMS released a change request to allow contractors to use alternate medical documentation to identify an illegible signature.
Effective date: August 25, 2015
Implementation date: August 25, 2015
View Transmittal R604PI.
Medicare contractor payments for hospital outpatient dental services in Jurisdiction K did not comply with requirements
On July 27, the Office of Inspector General (OIG) posted a report stating Medicare contractor payments to providers in Jurisdiction K (Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, and Vermont) for hospital outpatient dental services did not comply with Medicare requirements. Of the 100 dental services in the stratified random sample, 85 did not comply with Medicare requirements. OIG estimated that Medicare contractors improperly paid providers at least $2,276,853 for dental services provided during the period January 1, 2011, through December 31, 2013.
View the report.
OIG posts advisory opinion
On July 28, the OIG posted an advisory opinion regarding a hospital system’s proposal to lease non-clinician employees and to provide operational and management services to a related psychiatric hospital for an amount equal to the hospital system’s full costs.
View the opinion.
CMS releases projections of national health expenditures
On July 28, CMS posted a press release stating total healthcare spending growth is expected to average 5.8% in aggregate from 2014-2024, according to a report CMS’ Office of the Actuary. The authors noted that this rate of growth is substantially lower than the 9% average rate seen in the three decades before 2008.
View the press release.
Medicare Part B overpaid millions for selected outpatient drugs
On July 29, the OIG posted a report stating Medicare contractors in 13 jurisdictions overpaid providers $35.8 million for selected outpatient drugs between July 1, 2009, and June 30, 2012. For the majority of the overpayments (88%), providers billed either incorrect units of service or a combination of incorrect units of service and incorrect HCPCS codes. During the audit period, the Medicare claims processing systems did not have sufficient prepayment edits in place to prevent all overpayments. In particular, Medically Unlikely Edits did not exist for many of the HCPCS codes associated with the outpatient drugs in the review.
View the report.
CMS posts information updating speech generating device benefits
On July 29, CMS posted a final decision memorandum and accompanying fact sheet related to coverage of speech generating devices. Speech generating devices are considered to fall within the Medicare durable medical equipment (DME) benefit category. The current National Coverage Determination (NDC) for speech generating devices was established in 2001 and covers devices that generate speech for patients with a severe speech impairment. The 2001 NCD limits coverage to devices that are not capable of performing functions other than generating speech. Software that generates speech and is used on a laptop computer, tablet, or other non-DME device is also covered under the NCD implemented in 2001, but the device the software is used on is not covered.
View the final decision memorandum.
View the fact sheet.
Medicare prescription drug premiums projected to remain stable
On July 29, CMS posted a press release stating that the average premium for a basic Medicare Part D prescription drug plan in 2016 will remain stable, at an estimated $32.50 per month. This news comes despite the fact that total Part D costs per capita grew by almost 11% in 2014, driven largely by high-cost specialty drugs and their effect on spending in the catastrophic benefit phase.
View the press release.

Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

    Briefings on APCs
  • Briefings on APCs

    Worried about the complexities of the new rules under OPPS and APCs? Briefings on APCs helps you understand the new rules...

  • HIM Briefings

    Guiding Health Information Management professionals through the continuously changing field of medical records and toward a...

  • Briefings on Coding Compliance Strategies

    Submitting improper Medicare documentation can lead to denial of fees, payback, fines, and increased diligence from payers...

  • Briefings on HIPAA

    How can you minimize the impact of HIPAA? Subscribe to Briefings on HIPAA, your health information management resource for...

  • APCs Insider

    This HTML-based e-mail newsletter provides weekly tips and advice on the new ambulatory payment classifications regulations...

Most Popular