This week in Medicare updates–02/03/2016
OIG Advisory Opinion No. 16-01
On January 25, the OIG posted an advisory opinion in response to a request for an opinion regarding the use of a “preferred hospital” network as part of Medicare Supplemental Health Insurance (“Medigap”) policies, whereby the requesting party would indirectly contract with hospitals for discounts on the otherwise-applicable Medicare inpatient deductibles for their policyholders and, in turn, would provide a premium credit of $100 to policyholders who use a network hospital for an inpatient stay.
View Advisory Opinion 16-01.
Required billing updates for rural health clinics (RHC)
On January 26, CMS made public Transmittal 1596 related to billing for rural health clinics. The transmittal discusses the requirement effective April 1 for HCPCS codes on all rural health claims. Payment under the All Inclusive Rate methodology will not change under the new reporting requirement.
Effective date: April 1, 2016
Implementation date: April 4, 2016
View Transmittal R1596OTN.
CMS releases Guide to Preventing Readmissions among Racially and Ethnically Diverse Medicare Beneficiaries
On January 26, CMS’ Office of Minority Health published a press release regarding a new Guide to Preventing Readmissions among Racially and Ethnically Diverse Medicare Beneficiaries. The Guide was developed in collaboration with the Disparities Solutions Center at Massachusetts General Hospital and the National Opinion Research Center at the University of Chicago as part of the CMS Equity Plan for Improving Quality in Medicare. It is designed to assist hospital leaders and stakeholders focused on quality, safety, and care redesign identify root causes and solutions for preventing avoidable readmissions among racially and ethnically diverse Medicare beneficiaries.
View the press release.
Decision memo for stem cell transplantation (multiple myeloma, myelofibrosis, and sickle cell disease)
On January 27, CMS posted the final decision memorandum modifying its existing National Coverage Determinations Manual to expand national coverage for allogeneic hematopoietic stem cell transplantation for three separate medical conditions: multiple myeloma, myelofibrosis, and sickle cell disease.
View the final decision memorandum.
Proposed changes to the Medicare Shared Savings Program regulations
On January 28, CMS posted a fact sheet regarding a proposed rule that would update the methodology used to calculate the benchmarks of Accountable Care Organizations (ACO) that continue their participation in the Medicare Shared Savings Program after an initial three-year agreement period. This proposed rule expands upon issues discussed in the June 2015 Shared Savings Program final rule, in which CMS committed to engaging in additional rulemaking for modifications to the Shared Savings Program’s methodology for resetting benchmarks.
View the fact sheet.
View the press release.
Off-cycle update to the long term care hospital (LTCH) PPS FY 2016 Pricer
On January 29, CMS released a change request updating certain rates and factors in the LTCH PPS FY 2016 Pricer applicable to discharges occurring on or after January 1 due to a technical change in the Consolidated Appropriations Act of 2016. This change request also resulted in an update to the LTCH PPS FY 2016 high-cost outlier fixed-loss amount for site-neutral rate discharges. Please note that it will cause a reprocessing of all LTCH hospital claims from January 1 through the date of implementation by the MAC.
Effective date: January 1, 2016
Implementation date: April 4, 2016
View Transmittal R3445CP.
Revised letters for Redeterminations and Reconsiderations
On January 29, CMS released a change request addressing the Revision to the Redetermination and Reconsideration Revised Overpayment Letter Templates.
Effective date: March 1, 2016
Implementation date: March 1, 2016
View Transmittal R260FM.
Monitoring Overpayments Redetermination or Reconsideration Status
On January 29, CMS released a change request to provide instructions to the MACs for the monitoring of accounts receivable (AR), also referred to as overpayments, that are in a redetermination or reconsideration AR status code.
Effective date: March 1, 2016
Implementation date: March 1, 2016
View Transmittal R261FM.
Note regarding implementation of Section 603 of the Bipartisan Budget Act of 2015
On January 29, CMS posted a note on its Hospital Outpatient PPS website stating that it will be presenting its proposals for implementing Section 603 of the Bipartisan Budget Act of 2015 through the CY 2017 OPPS proposed rule. CMS is stating that, if there is a scenario regarding implementation of Section 603 that an organization is concerned about and want to call attention to for the proposed rule, it has created a mailbox for the public to send these scenarios.
View the note.