This week in Medicare updates–05/25/2016
Adoption of 2012 Life Safety and Health Care Facilities Code
On May 6, CMS posted a survey and certification letter for the final rule titled “Medicare and Medicaid Programs; Fire Safety Requirements for Certain Health Care Facilities,” which updates the fire safety requirements for health care providers and suppliers. This regulation requires certain providers and suppliers to meet the requirements of the 2012 edition of the Life Safety Code, National Fire Protection Association (NFPA) 101 and the 2012 edition of the Health Care Facilities Code, NFPA 99.
View the survey and certification letter.
2016 DME Prosthetics, Orthotics, and Supplies HCPCS code jurisdiction list
On May 10, CMS rescinded Transmittal 3432, dated December 31, 2015, and replaced it with Transmittal 3520 to revise the jurisdiction for HCPCS E0781 to DME MAC only and to omit the local carrier jurisdiction for this code in the attachment. All other information remains the same. The recurring update notification applies to Chapter 23, Medicare Claims Processing Manual, section 20.3.
Effective date: January 1, 2016
Implementation date: February 1, 2016
View Transmittal R3520CP.
View MLN Matters article MM9481.
Coding revisions to NCDs
On May 13, CMS released a change request serving as the seventh maintenance update of ICD-10 conversions and other coding updates specific to NCDs. Edits to ICD-10 and other coding updates specific to NCDs will be included in subsequent, quarterly releases as needed. No policy-related changes are included with these updates. Any policy-related changes to NCDs continue to be implemented via the current, long-standing NCD process.
Effective date: October 1, 2016, unless noted differently in requirements
Implementation date: October 3, 2016
View Transmittal R1665OTN.
View MLN Matters article MM9631.
July 2016 Integrated Outpatient Code Editor (I/OCE) Specifications Version 17.2
On May 13, CMS released 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: July 1, 2016
Implementation date: July 5, 2016
View Transmittal R3524CP.
View MLN Matters article MM9661.
July 2016 update of the hospital OPPS
On May 13, CMS released a recurring update notification describing changes to and billing instructions for various payment policies implemented in the July 2016 OPPS update. The July 2016 Integrated OCE (I/OCE) and OPPS pricer will reflect the HCPCS, APC, HCPCS modifier, and revenue code additions, changes, and deletions identified in this change request. This recurring update notification applies to Chapter 4, Medicare Claims Processing Manual, section 200.3.1.
Effective date: July 1, 2016
Implementation date: July 5, 2016
View Transmittal R3523CP.
Update to Internet-Only-Manual Publication 100-04, Medicare Claims Processing Manual, Chapter 18, section 30.6
On May 13, CMS released a change request replacing ICD-10 diagnosis code Z12.92 with ICD-10 diagnosis code Z12.72 in Pub. 100-04, Medicare Claims Processing Manual, Chapter 18, section 30.6. In addition, section 30.6 is revised and updated for clarity.
Effective date: June 14, 2016
Implementation date: June 14, 2016
View Transmittal R3522CP.
View MLN Matters article MM9606.
Inpatient psychiatric facilities (IPF) requirements for certification, recertification, and delayed/lapsed certification and recertification
On May 13, CMS released a change request to clarify physician certification, recertification, and delayed//lapsed certification and recertification with respect to IPF services in Medicare Benefit Policy Manual, Chapter 2, §30.2.1.
Effective date: August 15, 2016
Implementation date: August 15, 2016
View Transmittal R223BP.
View Transmittal R98GI.
View MLN Matters article MM9522.
Revisions to private contracting/opt-out manual sections due to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)
On May 13, CMS released a change request to revise Publication 100-02, "Medicare Benefit Policy Manual" consistent with the Medicare Access and CHIP Reauthorization Act of 2015 amendments.
Effective date: August 15, 2016
Implementation date: August 15, 2016
View Transmittal R222BP.
Outcome thresholds and revised guidelines for solid transplant programs
On May 16, CMS posted a survey and certification letter regarding transplant programs. Medicare CoPs require that each solid organ transplant program maintain patient and graft survival rates that are within certain CMS tolerance limits. A standard level deficiency requires improvement efforts but does not by itself put a program’s Medicare participation at risk. CMS is concerned that transplant programs may avoid using certain available organs that they believe might adversely affect the program’s outcome statistics. It expects that this revised policy, by lessening such concerns and augmenting the policy with other efforts, will promote more effective use of available organs and help more waitlisted individuals to benefit from a transplant, while continuing to promote high rates of patient and graft survival.
View the survey and certification letter.
Proposed collection; comment request
On May 16, CMS posted a notice in the Federal Register stating that it is accepting comments on CMS–838, Medicare Credit Balance Reporting Requirements; CMS–10157, HIPPA Eligibility Tracking System; and CMS–10469, Issuer Reporting Requirements for Selecting a Cost-Sharing Reductions Reconciliation Methodology. Comments are due July 15.
View the notice in the Federal Register.
Leave a comment.
Submission for OMB Review; Comment Request
On May 16, CMS posted a notice in the Federal Register stating that it is accepting comments on CMS–10409, Long Term Care Hospital (LCTH) Continuity Assessment Record and Evaluation (CARE) Data Set. Comments are due June 15.
View the notice in the Federal Register.
Leave a comment.
Medicare Compliance Review of Lafayette General Medical Center for claims paid during 2013 and 2014
On May 16, the OIG posted a report stating Lafayette General Medical Center, operating in Louisiana, complied with Medicare billing requirements for 34 of the 103 inpatient claims and all 31 outpatient claims. However, the hospital did not fully comply with Medicare billing requirements for the remaining 69 inpatient claims. On the basis of its sample results, the OIG estimated that the hospital received overpayments of at least $4.4 million for claims paid during 2013 and 2014.
View the report.
Obtaining final Medicare Secondary Payer conditional payment amounts via web portal
On May 17, CMS posted a final rule in the Federal Register specifying the process and timeline for expanding its existing Medicare Secondary Payer (MSP) web portal to conform to section 201 of the Medicare IVIG and Strengthening Medicare and Repaying Taxpayers Act of 2012. The final rule specifies a timeline for developing a multifactor authentication solution to securely permit authorized users other than the beneficiary to access CMS’ MSP conditional payment amounts and claims detail information via the MSP web portal. It also requires that CMS add functionality to the existing MSP web portal that permits users to: notify CMS that the specified case is approaching settlement; obtain time and date stamped final conditional payment summary statements and amounts before reaching settlement; and ensure that relatedness disputes and any other discrepancies are addressed within 11 business days of receipt of dispute documentation. It is effective June 16.
View the rule in the Federal Register.
Monitoring data shows adequacy of new payment amounts for DME, Prosthetics, Orthotics, and Supplies (DMEPOS) in non-competitively bid areas
On May 17, CMS posted a fact sheet stating that it posted monitoring data related to the DMEPOS competitive bidding program used to ensure that Medicare beneficiaries continue to receive the medical equipment they need. This data monitoring tracks access to items and services and a number of clinical outcome measures such as mortality, hospitalizations, and emergency room visits. By all measures, the DMEPOS competitive bidding program has been a great success for beneficiaries and the taxpayers.
View the fact sheet.
Track sheet on leadless pacemakers
On May 18, CMS posted a track sheet regarding leadless cardiac pacemakers. CMS is initiating an NCA to establish a national coverage determination for coverage of these devices. The initial 30-day public comment period begins with this posting date, and ends after 30 calendar days. CMS considers all public comments, and is particularly interested in clinical studies and other scientific information relevant to the topic under review.
View the track sheet.
Announcement of the Advisory Panel on Hospital Outpatient Payment meeting on August 22-23 and announcement of transition to one meeting per year
On May 20, CMS posted a notice in the Federal Register announcing the summer meeting of the Advisory Panel on Hospital Outpatient Payment for 2016. The meeting is scheduled for Monday, August 22, and Tuesday, August 23. It also announces that this panel will begin meeting once a year in the summer, beginning in calendar year 2017. Currently, the panel convenes twice yearly. The purpose of the panel is to advise the secretary of HHS and the administrator of CMS on the clinical integrity of the APC groups and their associated weights and hospital outpatient therapeutic services supervision issues.
View the notice in the Federal Register.