This week in Medicare–07/27/2016
Rescinded and replaced new waived tests transmittal
On July 15, CMS rescinded Transmittal 3550, dated June 24, and replaced it with Transmittal 3563 to correct three items in the attachment to the recurring update notification. The items corrected were the second bullet on page 5 for the Assure Tech Co., Ltd. AssureTech Amphetamine Dip Card was changed to Assure Tech Co., Ltd. AssureTech Amphetamine Quick Cup; the fourth bullet on page 12 for the Assure Tech Co., Ltd. AssureTech Morphine Strip was changed to the Assure Tech Co., Ltd. AssureTech Morphine Turn-Key Split Cup; and the CPT code for the Meridian Bioscience Immunocard STAT! HpSA (Stool) was changed to 87338QW. All other information remains the same.
Effective date: October 1, 2016
Implementation date: October 3, 2016
View Transmittal R3563CP.
Quarterly update to the CCI edits, Version 22.3
On July 15, CMS released the normal update to the CCI procedure-to-procedure edits. The attached recurring update notification applies to Pub. 100-04, Medicare Claims Processing Manual, Chapter 23, section 20.9.
Effective date: October 1, 2016
Implementation date: October 3, 2016
View Transmittal R3561CP.
View MLN Matters article MM9725.
Denial codes for missing or insufficient documentation
On July 15, CMS released a change request to update the codes that are to be used when a claim is denied due to missing or insufficient documentation.
Effective date: August 16, 2016
Implementation date: August 16, 2016
View Transmittal R663PI.
The Supplemental Security Income (SSI)/Medicare beneficiary data for FY 2014 for IPPS hospitals, inpatient rehabilitation facilities (IRF), and long term care hospitals (LTCH)
On July 15, CMS released a transmittal with instructions notifying MACs of the availability of updated data and instructions on how to access such data for determining the disproportionate share adjustment for IPPS hospitals and the low income patient adjustment for IRFs as well as payments as applicable for LTCH discharges. The SSI/Medicare beneficiary data for hospitals are available electronically and contains the name of the hospital, CMS certification number, SSI days, total Medicare days, and the ratio of Medicare Part A patient days attributable to SSI recipients.
Effective date: August 16, 2016
Implementation date: August 16, 2016
View Transmittal 1681OTN.
View MLN Matters article MM9648.
Submission for OMB review, comment request
On July 19, CMS posted a notice in the Federal Register stating that it is accepting comments on CMS–10295, Reporting Requirements for States Under Transitional Medical Assistance (TMA) Provisions; CMS–838, Medicare Credit Balance Reporting Requirements; CMS–10157, HIPPA Eligibility Tracking System; CMS–10309, Grandfathering Provisions of the Medicare DMEPOS Competitive Bidding Program; and CMS–R–199, Medicaid Report on Payables and Receivables. Comments are due August 18.
View the notice in the Federal Register.
Leave a comment.
Proposed collection, comment request
On July 19, CMS posted a notice in the Federal Register stating that it is accepting comments on CMS–R–64 Indirect Medical Education and Supporting Regulations. Comments are due September 19.
View the notice in the Federal Register.
Leave a comment.
Protecting patient personal health information
On July 20, CMS released a special edition MLN Matters article reminding physicians of the HIPAA requirement to protect the confidentiality of the PHI of their patients. Recently, CMS learned of a potential security breach in which someone was offering for sale over 650,000 records of orthopedic patients. A covered entity must notify the Secretary of HHS if it discovers a breach of unsecured protected health information. Pay attention to security issues that business associates, especially those entities that provide you with hardware and/or software support for your patient electronic health records, may experience. Business associates should report any actual or potential security breaches.
View MLN Matters article SE1616.
Adverse events in rehabilitation hospitals: national incidence among Medicare beneficiaries
On July 21, the OIG posted a report as part of a series on adverse events in healthcare settings, defined as harm resulting from medical care. Previous OIG work identified harm rates of about 30% in both acute-care hospitals and SNF, with an attendant toll on patient health and taxpayers' costs, the latter amounting to billions of dollars annually. This report extends the OIG’s work by evaluating care provided in rehabilitation hospitals. Rehabilitation hospitals are post-acute providers that specialize in intensive rehabilitative care for patients recovering from illness, injury, or surgery. An increased understanding of adverse events that occur in this unique setting would better equip healthcare providers and other stakeholders to improve the safety of patient care in rehab hospitals.
View the report.
Evaluation of national distributions of Overall Hospital Quality Star Ratings
On July 21, CMS released a fact sheet publishing some data showing the national distribution of Overall Hospital Star Ratings based on hospital characteristics. For each hospital characteristic, such as teaching status or safety net status, CMS evaluated the distribution of hospitals across the five star categories (1, 2, 3, 4, and 5 stars).
View the fact sheet.
Million Hearts® Cardiovascular Disease (CVD) Risk Reduction Model
On July 21, CMS released a fact sheet regarding The Million Hearts® CVD Risk Reduction Model, a trial that seeks to bridge a gap in cardiovascular care by providing targeted incentives for healthcare practitioners to engage in beneficiary CVD risk calculation and population-level risk management.
View the fact sheet.
View the press release.
Proposed collection, comment request
On July 22, CMS posted a notice in the Federal Register stating that it is accepting comments on CMS–R–70, Information Collection Requirements in HSQ–110, Acquisition, Protection and Disclosure of Peer review Organization Information and Supporting Regulations; CMS–R–72 Information Collection Requirements in 42 CFR 478.18, 478.34, 478.36, 478.42, QIO Reconsiderations and Appeals; CMS–R–247 Expanded Coverage for Diabetes Outpatient Self-Management Training Services and Supporting Regulations; CMS–10151 Data Collection for Medicare Beneficiaries Receiving Implantable Cardioverter-Defibrillators for Primary Prevention of Sudden Cardiac Death; CMS–10268 Consolidated Renal Operations in a Web Enabled Network (CROWNWeb) Third-party Submission Authorization Form; CMS–R–5 Physician Certification/ Recertification in Skilled Nursing Facilities (SNFs) Manual Instructions; CMS–10615 Healthy Indiana Program (HIP) 2.0 Beneficiaries Survey, Focus Groups, and Informational Interviews; and CMS–10062 Collection of Diagnostic Data from Medicare Advantage Organizations for Risk Adjusted Payments. Comments are due September 20.
View the notice in the Federal Register.
Leave a comment.
Notice of modification of OIG Advisory Opinion No. 10-12
On July 22, the OIG posted a modification of Advisory Opinion No. 10-12, regarding charities seeking to offer cost-sharing assistance.
View the modified opinion.
Scoresheet from lower extremity chronic venous disease meeting
On July 22, CMS posted the scoresheet from the Medicare Evidence Development & Coverage Advisory Committee meeting regarding lower extremity chronic venous disease that took place on July 20.
View the scoresheet.