This week in Medicare updates–07/13/2016
Clarifications to stem cell transplantation for multiple myeloma, myelofibrosis, sickle cell disease, and myelodysplastic syndromes change request
On July 1, CMS rescinded Transmittal 191, dated April 29, and replaced it with Transmittal 193 to provide clarifying language for references to the Pub. 100-03, NCD Manual, under Summary of Changes. All other information remains the same.
Effective date: January 27, 2016
Implementation date: October 3, 2016
View Transmittal R193NCD.
View Transmittal R3556CP.
View MLN Matters article MM9620.
Changes to OPPS July 2016 update transmittal
On July 1, CMS rescinded Transmittal 3552, dated June 28, and replaced it with Transmittal 3557. Section I.B.4 was revised to include the statement announcing the delay in implementation of the reporting for certain outpatient department services (that are similar to therapy services) (“non-therapy outpatient department services”) that are adjunctive to comprehensive APC procedures. All other information remains the same.
Effective date: July 1, 2016
Implementation date: July 5, 2016
View Transmittal R3557CP.
October 2016 quarterly update for the DME, prosthetics, orthotics, and supplies (DMEPOS) Competitive Bidding Program (CBP)
On July 1, CMS released a transmittal containing the October 2016 DMEPOS quarterly update. DME CBP files are updated on a quarterly basis 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. The recurring update notification applies to Chapter 23, Medicare Claims Processing Manual, section 100.
Effective date: October 1, 2016
Implementation date: October 3, 2016
View Transmittal R3554CP.
View MLN Matters article MM9701.
Date and timing requirements
On July 1, CMS released a change request to update language in Chapter 5, subsection 5.2.6 of Pub. 100-08, Medicare Program Integrity Manual, to clarify date and timing requirements as outlined in 42 CFR 410.38(g). Also, to update the Pub. 100-08 language to eliminate the date stamp requirement in the same section to provide consistency among the review contractors.
Effective date: August 1, 2016
Implementation date: August 1, 2016
View Transmittal R662PI.
Medicare Part A SNF PPS Pricer update FY 2017
On July 1, CMS released a change request providing information on the updates to the payment rates used under the PPS for SNFs, for FY 2017, as required by statute. The update can be found in Chapter 6, section 30.7 of the Medicare Claims Processing Manual.
Effective date: October 1, 2016
Implementation date: October 3, 2016
View Transmittal R3555CP.
View MLN Matters article MM9712.
OPPS 2017 proposed rule
On July 6, CMS released the 2017 OPPS proposed rule. It would revise the Medicare OPPS and the Medicare (ASC) payment system for CY 2017 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. It describes the proposed changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this proposed rule would update and refine the requirements for the Hospital Outpatient Quality Reporting Program and the ASC Quality Reporting Program. Comments are due September 6.
View the rule.
View the fact sheet.
View the press release.
Expanding uses of Medicare data by qualified entities
On July 7, CMS posted a final rule in the Federal Register implementing requirements under Section 105 of the Medicare Access and CHIP Reauthorization Act of 2015 that expand how qualified entities may use and disclose data under the qualified entity program to the extent consistent with applicable program requirements and other applicable laws, including information, privacy, security, and disclosure laws. It also explains how qualified entities may create nonpublic analyses and provide or sell such analyses to authorized users, as well as how qualified entities may provide or sell combined data, or provide Medicare claims data alone at no cost, to certain authorized users. In addition, this rule implements certain privacy and security requirements, and imposes assessments on qualified entities if the qualified entity or the authorized user violates the terms of a data use agreement required by the qualified entity program. The rule is effective September 6.
View the rule in the Federal Register.
View the press release.
Medicare physician fee schedule proposed rule
On July 7, CMS released the 2017 Medicare physician fee schedule proposed rule.
View the proposed rule.
View the fact sheet.
View the press release.
Leave a comment.
Medicare Diabetes Prevention Program expansion
On July 7, CMS posted a fact sheet regarding the Diabetes Prevention Program, a structured lifestyle intervention that includes dietary coaching, lifestyle intervention, and moderate physical activity, all with the goal of preventing the onset of diabetes in individuals who are pre-diabetic. The clinical intervention consists of 16 intensive core sessions of a curriculum in a group-based, classroom-style setting that provides practical training in long-term dietary change, increased physical activity, and behavior change strategies for weight control.
View the fact sheet.
Proposed decision memo for screening for hepatitis B virus (HBV) infection
On July 7, CMS posted a proposed decision memo stating that the evidence is sufficient to conclude that screening for HBV, consistent with the grade A and B recommendations by the U.S. Preventive Services Task Force, is reasonable and necessary for the prevention or early detection of an illness or disability and is appropriate for individuals entitled to benefits under Part A or enrolled under Part B, as described below. Therefore, CMS proposes to cover screening for HBV infection with the appropriate U.S. Food and Drug Administration (FDA) approved/cleared laboratory tests, used consistently with FDA approved labeling and in compliance with the CLIA regulations, when ordered by the beneficiary's primary care physician or practitioner within the context of a primary care setting, and performed by an eligible Medicare provider for these services, for beneficiaries who meet either of the specified conditions.
View the proposed decision memorandum.