Revenue Cycle

Important Medicare Updates

Medicare Update for CAHs, October 17, 2012

CMS issues preliminary decisions on recommendations of outpatient payment panel on supervision levels for select services

On September 24, CMS posted information on the hospital outpatient payment panel regarding the appropriate supervision levels for individual hospital outpatient therapeutic services. To view the panel’s decisions and recommendations, visit the link below.

CMS issues October 2012 NCD Coding Policy Manual and Change Report

CMS released the October 2012 Medicare National Coverage Determinations (NCD) Coding and Policy Manual and Change Report for clinical diagnostic laboratory services.

View the report.

CMS issues guidance on reducing avoidable hospitalizations among nursing facility residents

On September 27, CMS issued a fact sheet and press release both of which detailed the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents in which CMS is partnering with seven organizations to implement strategies to reduce avoidable hospitalizations for Medicare-Medicaid enrollees who are long-stay residents of nursing facilities.

View the fact sheet.

View the press release.

CMS replaces transmittal on manual medical review of therapy services

On September 24, CMS replaced transmittal R1117OTN, containing a notice which stated that all requests for physical therapy/speech-language pathology or occupational therapy services above $3,700 provided under Medicare Part B shall be approved in advance. Although this outpatient therapy caps and manual medical review for therapy services will not apply to CAHs in 2012, CMS has stated that this may apply in 2013.

View transmittal R1124OTN.

CMS issues corrections to administrative simplification final rule

On October 4, CMS issued corrections to the final rule titled, “Administration Simplification: Adoption of a Standard for a Unique Health Plan Identifier; Addition to the National Provider Identifier Requirements; and a Change to the Compliance Date for ICD-10.”

View the corrections.

CMS and NCHS issue 2013 ICD-10-CM official guidelines

On October 4, CMS and the National Center for Health Statistics (NCHS) released the guidelines for coding and reporting using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM).

View the 2013 guidelines.

CMS issues NCD for tumor antigen by immunoassay – CA 125 (190.28)

On October 5, CMS issued a national coverage determination for tumor antigen by immunoassay – CA 125 (190.28)

View the NCD.

CMS issues new waived tests

On September 28, CMS issued a transmittal that informs contractors of new CLIA waived tests approved by the Food and Drug Administration (FDA).

Effective date: January 1, 2013

Implementation date: January 7, 2013

View transmittal R2553CP.

View MLN Matters article MM8054.

CMS issues annual clotting factor furnishing fee update 2013

On September 28, CMS issued an annually recurring transmittal that announces the update to the clotting factor furnishing fee.

Effective date: January 1, 2013

Implementation date: January 7, 2013

View transmittal R2554CP.

View MLN Matters article MM8049.

CMS issues influenza vaccine payment allowances – annual update for 2012-2013 season

On September 28, CMS issued a recurring update notification that provides the payment allowances for seasonal influenza virus vaccines as updated on an annual basis effective August 1 of each year.

Effective date: August 1, 2012

Implementation date: December 28, 2012

View transmittal R2555CP.

On October 3, CMS replaced the transmittal above to change the implementation date to “no later than December 28, 2012” and to remove the italicized section of the summary of changes.

View transmittal R2562CP.

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