This week in Medicare updates–03/02/2016
Substantial revisions to QIO Manual for reviews involving potential administrative sanctions
On February 18, CMS released an extensive revision of QIO Manual Chapter 9 related to QIO reviews in cases potentially involving sanction recommendations from the OIG for quality and EMTALA issues. The chapter has been renamed to include the reference to EMTALA. This update supersedes all the information in the October 3, 2003 version of Chapter 9, any previously issued Question & Answer guidance, and any previously issued TOPS, Standard Data Processing System, and Healthcare Quality Information System memos related to Chapter 9.
Effective date: March 14, 2016
Implementation date: March 14, 2016
View Transmittal R139DEMO.
Comprehensive Care for Joint Replacement Model (CJR) provider education
On February 19, CMS released a change request to disseminate information to providers and the public about the CJR model. The intent of the CJR model is to promote quality and financial accountability for episodes of care surrounding a lower-extremity joint replacement (LEJR) or reattachment of a lower extremity procedure. CJR will test whether bundled payments to certain acute care hospitals for LEJR episodes of care will reduce Medicare expenditures while preserving or enhancing the quality of care for Medicare beneficiaries.
Effective date: April 1, 2016
Implementation date: April 4, 2016
View Transmittal R140DEMO.
View MLN Matters article MM9533.
April calendar year (CY) 2016 quarterly Medicare Physician Fee Schedule (MPFS) Database update
On February 19, CMS released a change request amending payment files issued to contractors based upon the CY 2016 MPFS final rule. This recurring update notification applies to Pub. 100-04, Medicare Claims Processing Manual, Chapter 23, section 30.1.
Effective date: January 1, 2016
Implementation date: April 4, 2016
View Transmittal R3469CP.
View MLN Matters article MM9531.
Guidance on the Physician Quality Reporting System 2014 reporting year and 2016 payment adjustment for rural health clinics, federally qualified health centers, and critical access hospitals
On February 19, CMS posted an MLN Matters® special edition article providing answers to some frequently asked questions raised by staff at RHCs, FQHCs, and CAHs.
View special edition MLN Matters article SE1606.
2017 Medicare Advantage and Part D Advance Notice and Draft Call Letter
On February 19, CMS posted a fact sheet stating it released proposed updates to the Medicare Advantage and Part D programs through the 2017 Advance Notice and Draft Call Letter. Through these policies, CMS is proposing updates to the program designed to improve the accuracy of payments to plans serving beneficiaries who are dually eligible for Medicare and Medicaid.
View the fact sheet.
View the press release.
Provider enrollment revalidation — Cycle 2
On February 22, CMS posted an MLN Matters® special edition article stating CMS has completed its initial round of revalidations and will be resuming regular revalidation cycles in accordance with 42 CFR §424.515. In an effort to streamline the revalidation process and reduce provider/supplier burden, CMS has implemented several revalidation processing improvements that are discussed within this article. This article is intended for all providers and suppliers who are enrolled in Medicare and required to revalidate through their MACs.
View special edition MLN Matters article SE1605.
Program integrity enhancements to the provider enrollment process
On February 25, CMS released a proposed rule as part of CMS’s ongoing and continuous effort to prevent questionable providers and suppliers from entering the Medicare program and enhance the agency’s ability to promptly identify and act on instances of improper behavior.
View the proposed rule.
View the fact sheet.