This week in Medicare updates–04/13/2016
Medicare Internet-Only Manual Publication 100-04 Chapter 26 - Completing and Processing Form CMS-1500 Data Set
On April 1, CMS rescinded Transmittal 3484, dated March 25, 2016, and replaced it with Transmittal 3490 to include the most current version of Pub 100-04, Chapter 26, Section 10.6, to also include the additional updates required to resolve the conflict with Pub 100-04, Medicare Claims Processing Manual, Chapter 1, section 80.3.1, and to remove the responsibility of MAC A and MAC HHH within the Business Requirements. All other information remains the same.
Effective date: April 25, 2016
Implementation date: April 25, 2016
View Transmittal R3490CP.
Provider Reimbursement Manual, Part 1–Chapter 31, Organ Acquisition Payment Policy
On April 1, CMS released a transmittal creating Chapter 31 of the Provider Reimbursement Manual. It has been created to update, reorganize, and clarify Medicare’s payment policy regarding organ acquisition costs, formerly found in Chapter 27–ESRD Services and Supplies, sections 2770 through 2775.4. Sections 2770 through 2775.4 have been removed and reserved. This chapter also incorporates corrections to terminology to reflect current usage; revisions of text to clarify meaning; additions, deletions or corrections to cross references; and revisions of section titles.
Effective date: Not applicable
View Transmittal R471PRI.
View special edition MLN Matters article SE1608.
Corrections to recoding in the Home Health (HH) Pricer Program
On April 1, CMS released a change request to install a corrected HH Pricer program. It also requires MACs to adjust claims to correct recoding errors that resulted in inaccurate payments. This recurring update notification applies to Chapter 10, Medicare Claims Processing Manual, section 70.5.
Effective date: January 1, 2016
Implementation date: April 25, 2016
View Transmittal R3487CP.
View MLN Matters article MM9608.
ESRD cost audits
On April 1, CMS released a change request to document CMS' expectations and requirements for the MACs and Figliozzi & Company, Inc., in completing the ESRD cost reports selected for the cost audits. CMS awarded the ESRD Cost Audit Contract to Figliozzi & Company on September 16, 2015.
Effective date: September 16, 2015
Implementation date: May 2, 2016
View the zip file containing Transmittal R1640OTN and a related document.
Claims Adjustment Reason Code (CARC) and Remittance Advice Remark Code (RARC) and Medicare Remit Easy Print and PC Print Update
On April 1, CMS released a change request to update the CARC and RARC lists and also instructs General Dynamics Information Technology Medicare System and Fiscal Intermediary Shared System to update Medicare Remit Easy Print and PC Print respectively.
Effective date: July 1, 2016
Implementation date: July 5, 2016
View Transmittal R3489CP.
View MLN Matters article MM9466.
DME, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program (CBP) July 2016 quarterly update
On April 1, CMS released a recurring update notification applies to Chapter 23, Medicare Claims Processing Manual, section 100. The DME CBP files are updated on a quarterly basis in order to implement necessary changes to the HCPCS, ZIP code, Single payment amount, and Supplier files. These requirements provide specific instruction for implementing the DMEPOS CBP files.
Effective date: July 1, 2016
Implementation date: July 5, 2016
View Transmittal R3488CP.
View MLN Matters article MM9572.
Personnel policies for individuals directing or performing non-waived tests
On April 1, CMS posted a policy memorandum that supersedes S&C-10-07-CLIA, “Consolidation of Personnel Policies for Individuals Directing or Performing Non-waived Tests under the CLIA.” CLIA surveyors will now accept Primary Source Verification (PSV) as evidence of compliance with the personnel qualifications mandated in Subpart M of the Clinical CLIA Regulations. If there are required elements in the personnel regulations that the PSV company does not verify, it is the laboratory director’s (LD) responsibility to ensure that these personnel qualifications are met by other means. CLIA personnel regulations and the policy on mandatory citations are not changing. Laboratories may choose to submit primary source verification for LD qualifications. Bachelor’s and Associate’s degrees in nursing meet the requirement for earning a degree in a biological science for, respectively, high-complexity testing personnel and moderate-complexity testing personnel.
View the survey and certification letter.
Medicare Advantage payments to Medicare Employer Retiree Plans
On April 4, CMS posted a fact sheet stating that, beginning in calendar year 2017, it will implement an alternative payment policy for Medicare Employer Retiree Plans (Employer Group Waiver Plans), which will facilitate employers and unions offering high quality coverage for Medicare eligible retirees. CMS will establish payment amounts for Medicare Employer Retiree Plans based on non-Medicare Employer Retiree plan bids rather than establishing their payment amounts through bidding.
View the fact sheet.
Supporting Medicare in Puerto Rico
On April 4, CMS posted fact sheet stating that CMS proposed a number of important changes to the Medicare Advantage and Part D programs that, as finalized in the 2017 Rate Announcement and Final Call Letter, will improve stability in the Medicare Advantage program in Puerto Rico. Over the past year, the department has worked with stakeholders and the government of Puerto Rico to solicit input on opportunities to support healthcare delivery in Puerto Rico.
View the fact sheet.
Strengthening Medicare Advantage and Part D
On April 4, CMS released final updates to the Medicare Advantage and Part D programs through the 2017 Rate Announcement and Call Letter. These policies seek to provide stable payments to plans and make improvements to the program for plans that provide high-quality care to the most vulnerable beneficiaries.
View the fact sheet.
First Coast Service Options’ payments to providers for hospital outpatient dental services in Jurisdiction N generally did not comply with Medicare requirements
On April 8, the OIG posted a report stating that the payments that First Coast Service Options (FCSO) made to providers in Jurisdiction N (Florida, Puerto Rico, and the U.S. Virgin Islands) for hospital outpatient dental services generally did not comply with Medicare requirements. Of the 100 dental services in the stratified random sample, 95 did not comply with Medicare requirements. Using the sample results, the OIG estimated that FCSO improperly paid providers in Jurisdiction N at least $1 million from January 1, 2012, through August 31, 2014.
View the report.
Medicare Compliance Review of Saint Louis University Hospital for 2011 and 2012
On April 8, the OIG posted a report stating that Saint Louis University Hospital, operating in Saint Louis, Missouri complied with Medicare billing requirements for 243 of the 261 outpatient and inpatient claims reviewed. However, the hospital did not fully comply with Medicare billing requirements for the remaining 18 claims, resulting in net overpayments of $119,000 for calendar years 2011 and 2012. Specifically, four outpatient claims had billing errors, resulting in overpayments of more than $65,000, and 14 inpatient claims had a billing error, resulting in net overpayments of more than $53,000. 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.
April 2016 issue of Medicare Quarterly Provider Compliance Newsletter
CMS released the April 2016 issue of the Medicare Quarterly Provider Compliance Newsletter. This issue addresses common Recovery Audit and Comprehensive Error Rate Testing findings that impact ambulance suppliers, physicians, providers, Independent Diagnostic Testing Facilities, hospitals, ambulatory surgical centers, outpatient providers, and DME suppliers.
View the newsletter.