This week in Medicare updates–02/10/2016
FY 2015 Report to Congress (RTC): Review of Medicare’s program oversight of Accrediting Organizations (AO) and the CLIA Validation Program
On January 29, CMS posted a survey and certification letter regarding the 2015 annual RTC detailing the review, validation, and oversight of the FY 2014 activities of the approved AOs’ Medicare accreditation programs as well as the CLIA Validation Program. Section 1875(b) of the Social Security Act requires CMS to submit an annual report to Congress on its oversight of national AOs and their CMS-approved accreditation programs. Section 353(e)(3) of the Public Health Service Act requires CMS to submit an annual report of the CLIA validation program results.
View the survey and certification letter.
Expanding uses of Medicare data by qualified entities
On February 2, CMS posted a proposed rule in the Federal Register that would implement new statutory requirements that would expand how qualified entities may use and disclose data under the qualified entity program to the extent consistent with applicable program requirements and other applicable laws, including information, privacy, security, and disclosure laws. In doing so, this proposed rule would explain how qualified entities may create non-public analyses and provide or sell such analyses to authorized users, as well as how qualified entities may provide or sell combined data, or provide Medicare claims data alone at no cost, to certain authorized users. Comments are due March 29.
View the proposed rule in the Federal Register.
Leave a comment.
Request for an exception to the prohibition on expansion of facility capacity under the Hospital Ownership and Rural Provider Exceptions to the Physician Self-Referral Prohibition
On February 2, CMS posted a notice in the Federal Register stating it has received a request from a physician-owned hospital for an exception to the prohibition against expansion of facility capacity. This notice solicits comments on the request from individuals and entities in the community in which the physician-owned hospital is located. Community input may inform determination regarding whether the requesting hospital qualifies for an exception to the prohibition against expansion of facility capacity. Comments are due March 3.
View the notice in the Federal Register.
Leave a comment.
Announcement of the extended temporary moratoria on enrollment of ground ambulance suppliers and home health agencies in designated geographic locations
On February 2, CMS posted a notice in the Federal Register announcing the extension of temporary moratoria on the enrollment of new Medicare Part B ground ambulance suppliers and Medicare home health agencies, subunits, and branch locations in specific locations within designated metropolitan areas in Florida, Illinois, Michigan, Texas, Pennsylvania, and New Jersey to prevent and combat fraud, waste, and abuse.
View the notice in the Federal Register.
Extension of comment period for certification frequency and requirements for the reporting of quality measures under CMS programs
On February 2, CMS posted a notice in the Federal Register extending the comment period for the December 31, 2015 request for information entitled ‘‘Request for Information: Certification Frequency and Requirements for the Reporting of Quality Measures Under CMS Programs’’ (80 FR 81824) (referred to in this document as December 31 RFI). The comment period for the December 31, 2015, request for information, which would have ended on February 1, is extended for 15 days: it now ends on February 16.
View the notice in the Federal Register.
Accountable Care Organizations (ACO)-revised benchmark rebasing methodology, facilitating transition to performance-based risk, and administrative finality of financial calculations
On February 3, CMS posted a proposed rule in the Federal Register addressing changes to the Shared Savings Program that would modify the program’s benchmark rebasing methodology to encourage ACOs’ continued investment in care coordination and quality improvement, and identifies publicly available data to support modeling and analysis of these proposed changes. In addition, it would streamline the methodology used to adjust an ACO’s historical benchmark for changes in its ACO participant composition, offer an alternative participation option to encourage ACOs to enter performance-based risk arrangements earlier in their participation under the program, and establish policies for reopening of payment determinations to make corrections after financial calculations have been performed and ACO shared savings and shared losses for a performance year have been determined. Comments are due March 28.
View the proposed rule in the Federal Register.
Leave a comment.
Medicare Compliance Review of University of Minnesota Medical Center for 2012 and 2013
On February 3, the OIG posted a report detailing the Medicare Compliance Review of Minnesota Medical Center. The facility complied with Medicare billing requirements for 125 of the 255 inpatient and outpatient claims reviewed. However, it did not fully comply with Medicare billing requirements for the remaining 130 claims, resulting in overpayments of $565,000 for CYs 2012 and 2013 (audit period). On the basis of the sample results, the OIG estimated that the facility received overpayments totaling at least $3.3 million for the audit period.
View the report.
Correction to applying therapy caps to Maryland hospitals and billing requirement for rehabilitation agencies and comprehensive outpatient rehabilitation facilities (CORF)
On February 4, CMS posted a change request modifying the requirements of CR 9223 to ensure therapy caps are applied correctly to claims from certain Maryland hospitals.
Effective date: For all business requirements, dates of service on or after January 1, 2016. For rehabilitation agency and CORF billing requirement, dates of service on or after July 1, 2016.
Implementation date: July 5, 2016
View Transmittal R3454CP.
Updating the Fiscal Intermediary Shared System (FISS) to make payment for drugs and biologicals services for OPPS providers
On February 4, CMS released a change request implementing system changes to the FISS and Integrated OCE necessary to make payment for drugs and biologicals to OPPS providers.
Effective date: July 1, 2016
Implementation date: July 5, 2016
View Transmittal R1616OTN.
Advance Care Planning (ACP) services furnished by rural health clinics (RHC)
On February 4, CMS released a change request providing instruction on how to apply coinsurance when ACP services are furnished in RHCs.
Effective date: January 1, 2016
Implementation date: July 5, 2016
View Transmittal R1615OTN.
Update to Pub. 100-08, Medicare Program Integrity Manual, Chapter 15
On February 4, CMS released a change request that makes several minor revisions to Chapter 15 of Pub. 100-08. These changes include, but are not limited to: (1) clarifying the process for verifying correspondence telephone numbers; (2) clarifying the process for validating the credentials of technicians of independent diagnostic testing facilities; and (3) identifying the timeframe by which approval letters must be sent and to whom they must be sent.
Effective date: March 4, 2016
Implementation date: March 4, 2016
View Transmittal R636PI.
April 2016 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and revisions to prior quarterly pricing files
On February 4, CMS released a change request stating the ASP methodology 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, Medicare Claims Processing Manual, section 50 of the IOM.
Effective date: April 1, 2016
Implementation date: April 4, 2016
View Transmittal R3450CP.
Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) Meeting 4/27/2016-Treatment Resistant Depression
On February 4, CMS announced it will convene a panel of the MEDCAC on April 27. The purpose of this meeting is to obtain the MEDCAC's recommendations regarding the definition of treatment resistant depression (TRD) in clinical research as well as advise CMS on the use of the definition of TRD in the context of coverage with evidence development and treatment outcomes. MEDCAC panels do not make coverage determinations, but may advise CMS how to use evidence as the basis for any future coverage decisions.
View the announcement.
Proposed Collection; Comment Request
On February 5, CMS posted a notice in the Federal Register relating that it is accepting comments on: CMS–10406, Medicare Probable Fraud Measurement Pilot; CMS–10599, Medicare Prior Authorization of Home Health Services Demonstration. Comments are due April 5.
View the notice in the Federal Register.
Leave a comment.