This week in Medicare updates–06/22/2016
Proposed collection; comment request
On June 13, CMS posted a notice in the Federal Register stating that it is accepting comments on CMS–R–142, Examination and Treatment for Emergency Medical Conditions and Women in Labor; and CMS–588, Electronic Funds Transfer Authorization Agreement. Comments are due August 9.
View the notice in the Federal Register.
Leave a comment.
Proposed collection; comment request
On June 13, CMS posted a notice in the Federal Register stating that it is accepting comments on CMS–10105, National Implementation of In-Center Hemodialysis CAHPS Survey; CMS–10191, Medicare Parts C and D Program Audit Protocols and Data Requests; CMS–10525, Program of all-Inclusive Care for the Elderly (PACE) Quality Data Entry in CMS Health Plan Monitoring System; CMS–10623, Testing Experience and Functional Tools Demonstration: Personal Health Record (PHR) User Survey; CMS–R–246, Medicare Advantage, Medicare Part D, and Medicare Fee-For-Service Consumer Assessment of Healthcare Providers and Systems(CAHPS) Survey. Comments are due August 12.
View the notice in the Federal Register.
Leave a comment.
Submission for OMB review; comment request
On June 13, CMS posted a notice in the Federal Register stating that it is accepting comments on CMS 10066, Detailed Notice of Discharge and Supporting Regulations in 42 CFR 405.1206 and 422.622; CMS-R-193, Important Message from Medicare; and CMS-R-282, Medicare Advantage Appeals and Grievance Data Disclosure Requirements (42 CFR 422.111). Comments are due July 13.
View the notice in the Federal Register.
Leave a comment.
New physician specialty code for dentist
On June 15, CMS rescinded Transmittal 262, dated January 29, and replaced it with Transmittal 268 to change the effective date to January 1, 2017, although the effective date for MCS remains July 1, 2017, and to change the full implementation date to January 3, 2017, although the implementation date remains July 5 for MCS; and to remove DME MACs from the responsibility list for Business Requirement 9355.06.2. All other information remains the same.
Effective date: July 1, 2017, for MCS; January 1, 2017, for MACs
Implementation date: July 5, 2016, for MCS, January 3, 2017, for MACs
View Transmittal R268FM.
View Transmittal R3544CP.
Medical review of SNF PPS bills
On June 16, CMS rescinded Transmittal 651, dated May 27, and replaced it with Transmittal 656 to include sections 6.1.1 through 6.1.5 the table in Section II, replace the reference to Transmittal 594 with Pub. 100-04, Chapter 30, section 20 in section 6.1.2 B, correct the Provider Reimbursement Manual reference in section 6.1.4 B, and other minor edits that do not affect the policy. All other information remains the same.
Effective date: June 28, 2016
Implementation date: June 28, 2016
View Transmittal R656PI.
Hospital and critical access hospital (CAH) changes to promote innovation, flexibility, and improvement in patient care
On June 16, CMS posted a proposed rule in the Federal Register that would update the requirements hospitals and CAHs must meet to participate in the Medicare and Medicaid programs. These proposals are intended to modify the requirements to conform with current standards of practice and support improvements in quality of care, reduce barriers to care, and reduce some issues that may exacerbate workforce shortage concerns. Comments are due by August 15.
View the proposed rule in the Federal Register.
View the fact sheet.
View the press release.
Leave a comment.
Medicare improperly paid hospitals for beneficiaries who had not received 96 or more consecutive hours of mechanical ventilation
On June 16, the OIG posted a report stating that, for 137 of the 200 claims it reviewed, Medicare payments to hospitals complied with Medicare requirements; the beneficiaries had received 96 or more consecutive hours of mechanical ventilation. However, for the 63 remaining claims, Medicare payments to hospitals did not comply with requirements. Consequently, the claims were assigned incorrectly to MS-DRGs 207 and 870, resulting in $1.5 million of overpayments.
View the report.
CMS is taking steps to improve oversight of provider-based facilities, but vulnerabilities remain
On June 16, the OIG posted a report stating that it reviewed CMS' oversight of provider-based billing to ensure that only facilities that met provider-based requirements were receiving higher payments allowed by the provider-based designation. Under Medicare, payments for services performed in provider-based facilities are often more than 50% higher than payments for the same services performed in a freestanding facility. This increased cost is borne by both Medicare and its beneficiaries. Provider based is a Medicare payment designation established by the Social Security Act that allows facilities owned by and integrated with a hospital to bill Medicare as a hospital outpatient department, resulting in these facilities generally receiving higher payments than freestanding facilities. Provider-based facilities, which may be on or off the main hospital campus, must meet certain requirements (e.g., the facility generally must operate under the same license as the hospital). In addition, under current policy, hospitals may, but are not required to, attest to CMS that their provider-based facilities meet requirements to bill as a hospital outpatient department.
View the report.