This week in Medicare updates–05/18/2016
Rural health clinics (RHC) HCPCS reporting requirement and billing updates
On May 9, CMS released a special edition MLN Matters article to assist RHCs in meeting the requirements to report the HCPCS code for each service furnished along with the revenue code on claims to Medicare effective for dates of service on or after April 1.
View MLN Matters SE1611.
Federal Register publication of Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive Under the Physician Fee Schedule
On May 9, CMS published the proposed rule regarding MIPS and APM, with criteria for physician-focused payment models in the Federal Register. Click here to see HCPro’s news brief on this rule.
View the proposed rule in the Federal Register.
OIG Advisory Opinion No. 16-06
On May 9, the OIG posted OIG Advisory Opinion No. 16-06 regarding a proposal for an entity to purchase the remaining 5% ownership interest in a group purchasing organization (GPO), which would result in the GPO being wholly owned by an entity whose parent company also wholly owns some of the members of the GPO.
View the opinion.
Announcement of requirements and registration for “A Bill You Can Understand” Design and Innovation Challenge
On May 10, CMS posted a notice in the Federal Register announcing a challenge to engage those in the healthcare community, as well as new players from other industries, such as human-centered design and digital technology, to help in redesigning the “Medical Bill” or the “Medical Billing Process.” The goal of the challenge is to help patients understand their medical bills and the financial aspect of health. Submission dates run from May 9 through August 10, and judging dates run from August 20 through September 10.
View the notice in the Federal Register.
Medicare benefit integrity contractors' activities in 2012 and 2013: A data compendium
On May 10, the OIG posted a report providing a visual representation of data on the workload activities of Medicare benefit integrity contractors in calendar years 2012 and 2013. The report allows for a quick comparison of workload statistics across the two years, across contractors, and across Medicare programs. It also provides a baseline for reviewing contractors' quantitative results over time.
View the report.
Percutaneous left atrial appendage closure (LAAC)
On May 10, CMS posted an NCD regarding the coverage of percutaneous LAAC on its NCD website. Two transmittals have now been released regarding this NCD.
View the NCD website.
View Transmittal R3515CP.
View Transmittal R192NCD.
Proposed collection; comment request
On May 11, CMS posted a notice in the Federal Register stating that it is accepting comments on: CMS–10261, Part C Medicare Advantage Reporting Requirements and Supporting Regulations in 42 CFR 422.516(a); CMS–10295 Reporting Requirements for States Under Transitional Medical Assistance (TMA) Provisions; and CMS–10463, Cooperative Agreement To Support Navigators in Federally Facilitated and State Partnership Exchanges. Comments are due July 11.
View the notice in the Federal Register.
Leave a comment.
Submission for OMB review; comment request
On May 11, CMS posted a notice in the Federal Register stating that it is accepting comments on CMS–484, Attending Physician’s Certification of Medical Necessity and Supporting Documentation Requirements; CMS–846, 854, 847, 848, 849, 10125, 10126, Durable Medical Equipment Medicare Administrative Contractors (MAC) Regional Carrier, Certificate of Medical Necessity and Supporting Documentation; and CMS–10152 Data Collection for Medicare Beneficiaries Receiving NaF–18 Positron Emission Tomography (PET) to Identify Bone Metastasis in Cancer. Comments are due June 10.
View the notice in the Federal Register.
Leave a comment.
Notice of Modification of OIG Advisory Opinion No. 10-07
On May 11, the OIG posted a modification to Advisory Opinion No. 10-07. On May 21, 2014, the OIG issued a Supplemental Special Advisory Bulletin regarding Independent Charity Patient Assistance Programs. This supplemental bulletin provides additional guidance to patient assistance programs operated by independent charities to address certain risks about these programs. The OIG sent the supplemental bulletin, together with targeted letters, to all independent charities that have received favorable advisory opinions to request certain clarifications and modifications to those opinions.
View the opinion.
HHS met many requirements of the Improper Payments Information Act (IPIA) of 2002 but did not fully comply for FY 2015
On May 12, the OIG posted a report stating Ernst & Young (EY), LLP, under its contract with the OIG, audited FY 2015 HHS improper payment information reported in the Agency Financial Report to determine compliance with IPIA and related guidance from the Office of Management and Budget. EY determined HHS met many requirements but did not fully comply with IPIA. EY also determined HHS did not achieve an improper payment rate of less than 10% for the Medicare Fee-for-Service program and did not meet improper payment rate reduction targets for the Medicare Advantage program.
View the report.
Public meeting regarding new and reconsidered clinical diagnostic laboratory test codes for the clinical laboratory fee schedule (CLFS) for calendar year (CY) 2017
On May 13, CMS posted a notice in the Federal Register announcing a public meeting to receive comments and recommendations from the public on the appropriate basis for establishing payment amounts for new or substantially revised HCPCS codes being considered for Medicare payment under the CLFS for CY 2017. This meeting also provides a forum for those who submitted certain reconsideration requests regarding final determinations made last year on new test codes and for the public to provide comment on the requests. The public meeting is scheduled for Monday, July 18, from 9 a.m. to 3:00 p.m. Eastern.
View the notice in the Federal Register.