This week in Medicare updates–03/23/2016
Implementation of the award for Jurisdiction A DME MAC workload
On March 11, CMS posted a transmittal stating it awarded Noridian Healthcare Solutions, LLC, a new contract for the administration of Medicare Fee-for-Service claims for DME, prosthetics, orthotics, and supplies in Jurisdiction A. The incumbent is NHIC, Corp. The Jurisdiction A DME MAC serves Medicare beneficiaries who reside in the states of Connecticut, Delaware, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont, and the District of Columbia.
Effective date: December 16, 2015
Implementation date: July 1, 2016, for all cutover requirements outside of those related to system changes; July 5, 2016, for system changes
View Transmittal R1634OTN.
View MLN Matters article MM9546.
April 2016 Integrated Outpatient Code Editor (I/OCE) Specifications Version 17.1
On March 11, CMS posted a change request providing the I/OCE instructions and specifications for the I/OCE that will be utilized under the OPPS and Non-OPPS for hospital outpatient departments, community mental health centers, all non-OPPS providers, and for limited services when provided in a home health agency not under the home health PPS or to a hospice patient for the treatment of a non-terminal illness. The attached recurring update notification applies to 100-04, Chapter 4, Medicare Claims Processing Manual, section 40.1.
Effective date: April 1, 2016
Implementation date: April 4, 2016
View Transmittal R3477CP.
View MLN Matters article MM9553.
Telehealth Services
On March 11, CMS released a change request to display the list of telehealth services that were once available through the manual updates to now be displayed via a weblink going forward. CMS is also adding CRNAs to the list of Medicare practitioners who may bill for covered telehealth services. Lastly, the telehealth language has been removed from Pub 100.02, Medicare Benefit Policy Manual, Chapter 15, Section 270 and a reference added in text to see Pub 100.04, Chapter 12, Medicare Claims Processing Manual, section 190 for further information regarding telehealth services.
Effective date: January 1, 2015
Implementation date: April 11, 2016
View Transmittal R3476CP.
View Transmittal R221BP.
View MLN Matters article MM9428.
Settlement effectuation instructions for HHS Office of Medicare Hearings and Appeals (OMHA) Settlement Conference Facilitation (SCF) Pilot related to Part A appeals
On March 11, CMS released a change request to provide instructions for the effectuation of Part A claims and payments that are associated with the OMHA SCF Pilot. The OMHA SCF Pilot is an alternative dispute resolution process designed to bring an appellant and CMS together to discuss a mutually agreeable resolution to claims appealed to an ALJ hearing. If a resolution is reached, a settlement document is drafted by the facilitator to reflect the agreement and the document is signed by the appellant and CMS at the settlement conference session. When the OMHA SCF process results in a settlement between CMS and the appellant (provider, physician, or supplier), the pending appeals at the ALJ level which are included in the settlement will be dismissed. If CMS and the appellant provider, physician, or supplier do not agree to a settlement, the associated appeals will proceed through the standard ALJ process.
Effective date: April 11, 2016
Implementation date: April 11, 2016
View Transmittal R1633OTN.
April 2016 update of the ASC payment system
On March 11, CMS released a recurring update notification describes changes to billing instructions for various payment policies implemented in the April 2016 ASC payment system update. This recurring update notification applies to Chapter 14, Medicare Claims Processing Manual, section 10. As appropriate, this notification also includes updates to HCPCS.
Effective date: April 1, 2016
Implementation date: April 4, 2016
View Transmittal R3478CP.
View MLN Matters article MM9557.
Interpretive Guidelines for the Organ Transplant Conditions of Participation (CoPs) at 42 Code of Federal Regulations (CFR) §§ 482.68 through 482.104
On March 11, CMS posted a survey and certification letter regarding an Organ Transplant Interpretive Guidelines update. It is an advance copy of the Interpretive Guidelines for the Transplant CoPs at 42 CFR §§ 482.68 through 482.104. CMS updated these guidelines to incorporate previously-published changes, clarify certain areas, and address feedback received based on previously-released drafts. These Interpretive Guidelines supersede all previous versions and will be published in a new Appendix X of the State Operations Manual.
View the survey and certification letter.
Medicare Compliance Review of Billings Clinic Hospital for 2012 and 2013
On March 15, the OIG posted a report stating that Billings Clinic Hospital, operating in Billings, Montana, complied with Medicare billing requirements for 173 of the 179 outpatient and inpatient claims reviewed. However, the hospital did not fully comply with Medicare billing requirements for the remaining six claims, resulting in overpayments of approximately $57,000 for calendar years 2012 and 2013. Specifically, five outpatient claims had billing errors, resulting in overpayments of $52,000, and one inpatient claim had a billing error, resulting in an overpayment of $4,500. These errors occurred primarily because the hospital did not have adequate controls to prevent the incorrect billing of Medicare claims within the selected risk areas that contained errors.
View the report.
Competitive Bidding Program continues to maintain access and quality while saving Medicare billions
On March 15, CMS announced the new single payment amounts and began sending contract offers to successful bidders for Medicare’s Round 2 Recompete and the national mail-order recompete DME, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program. These new payment amounts and contracts go into effect on July 1. This program has been an essential tool to help Medicare set appropriate payment rates for DMEPOS items and save money for beneficiaries and taxpayers while ensuring access to quality items.
View the fact sheet.
Special edition MLN Matters articles regarding billing chiropractic service
On March 16, CMS released three special edition MLN Matters articles on submitting claims to MACs for chiropractic services provided to Medicare beneficiaries. Special edition MLN Matters article SE 1601 helps clarify the CMS policy regarding Medicare coverage of chiropractic services and documentation requirements for the beneficiary’s initial visit and subsequent visits to the chiropractor. Special edition MLN Matters article SE 1602 explains the Active Treatment modifier, which was developed to clearly define the difference between active treatment and maintenance treatment. Special edition MLN Matters article SE1603 provides a detailed list of informational/educational resources that can help chiropractors avoid billing errors due to insufficient or inaccurate documentation.
View special edition MLN Matters article SE 1601.
View special edition MLN Matters article SE 1602.
View special edition MLN Matters article SE1603.
CMS releases interactive Mapping Medicare Disparities tool
On March 17, CMS’ Office of Minority Health (CMS OMH) released a new interactive map to increase understanding of geographic disparities in chronic disease among Medicare beneficiaries. The Mapping Medicare Disparities (MMD) Tool identifies disparities in health outcomes, utilization, and spending by race and ethnicity and geographic location. Understanding geographic differences in disparities is important to informing policy decisions and efficiently targeting populations and geographies for interventions.
View the press release.
Proposed collection; comment request
On March 18, CMS posted a notice in the Federal Register stating that it is accepting comments on: CMS–10443, Transcatheter Valve Therapy Registry and KCCQ–10. Comments are due May 17.
View the notice in the Federal Register.
Leave a comment.
Update on IPPS 0.2% reduction
On March 18, CMS posted a notice in the Federal Register stating that, pursuant to the court’s October 6, 2015, order in Shands Jacksonville Medical Center, Inc., v. Sebelius, No. 14–263 (D.D.C.) and consolidated cases that challenge the 0.2% reduction in FY 2014 IPPS rates to account for the estimated $220 million in additional FY 2014 expenditures resulting from the 2-midnight policy, CMS is currently scheduled to publish a notice in the Federal Register responding to comments it has received on these issues, including comments received in response to the December 1, 2015, notice with comment period (80 FR 75107). CMS has moved the court to extend the March 18 deadline until April 27. It anticipates publishing the notice on or before April 27.
View the notice in the Federal Register.
OIG Advisory Opinion No. 16-03
On March 18, the OIG posted a response to a request for an advisory opinion regarding the use of a "preferred hospital" network as part of Medicare Supplemental Health Insurance ("Medigap") policies, whereby two insurance companies 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 16-03.