This week in Medicare updates–07/20/2016
QIO Manual Chapter 12, “Communications, Outreach, and Program-related Information Activities”
On July 8, CMS released a change request that serves as a revision of the QIO Manual. It provides general updated language consistent with current program operations and removes outdated operational instructions that the program updates and maintains outside of the QIO Manual.
Effective date: July 8, 2016
Implementation date: July 8, 2016
View Transmittal R27QIO.
QIO Manual Chapter 11, Hospital Payment Monitoring Program (HPMP)
On July 8, CMS released a transmittal that serves to delete QIO Manual Chapter 11.
Effective date: July 8, 2016
Implementation date: July 8, 2016
View Transmittal R25QIO.
QIO Manual Chapter 2, Eligibility
On July 8, CMS released a transmittal ensuring Chapter 2 of the QIO Manual is rescinded. Information about QIO eligibility and contract renewal is now addressed in Chapter 1 of the QIO Manual.
Effective date: July 8, 2016
Implementation date: July 8, 2016
View Transmittal R26QIO.
Fourth quarter FY 2016 notification of new interest rate for Medicare overpayments and underpayments
On July 8, CMS released a transmittal to give notice of a new interest rate for overpayments and underpayments for the fourth quarter of FY 2016. Medicare Regulation 42 CFR Section 405.378 provides for the charging and payment of interest on overpayments and underpayments to Medicare providers. The Secretary of Treasury utilizes the most comprehensive data available on consumer interest rates to determine the certified rate. Interest is assessed on delinquent debts to protect the Medicare Trust Funds. The attached recurring update notification applies to Chapter 3, Medicare Claims Processing Manual, section 10.
Effective date: July 18, 2016
Implementation date: July 18, 2016
View Transmittal R270FM.
Notice of proposed rulemaking for Organ Procurement Organizations (OPO) and Transplant Centers
On July 8, CMS posted a survey and certification letter regarding the OPPS proposed rules potential changes for OPOs and Transplant Centers. To learn more about the proposed rule, please visit: https://www.federalregister.gov/public-inspection.
View the survey and certification letter.
July 2016 Medicare Quarterly Provider Compliance Newsletter
CMS released the July 2016 Medicare Quarterly Provider Compliance Newsletter. This issue addresses common Comprehensive Error Rate Testing findings as well as an OIG report finding that impacts physician assistants, nurse practitioners, physicians, dentists, DME suppliers, hospitals, clinical nurse specialist, and providers performing hospital outpatient dental services.
View the newsletter.
Florida physical therapy practice claimed unallowable Medicare Part B reimbursement for some outpatient therapy services
On July 12, the OIG posted a report stating that a Florida physical therapy practice properly claimed Medicare reimbursement on 87 of 100 beneficiary claim days sampled. However, it improperly claimed Medicare reimbursement on the remaining 13 beneficiary claim days. These deficiencies occurred because this practice did not have adequate policies and procedures in place to ensure that it billed for services that complied with Medicare requirements. On the basis of the sample results, the OIG estimated that the practice improperly received at least $55,000 in Medicare reimbursement for outpatient physical therapy services that did not comply with certain Medicare requirements for calendar years 2012 and 2013.
View the report.
Medicare Compliance Review of University of Tennessee Medical Center
On July 12, the OIG posted a report stating that the University of Tennessee Medical Center complied with Medicare billing requirements for 219 of the 236 inpatient and outpatient claims reviewed. However, the hospital did not fully comply with Medicare billing requirements for the remaining 17 claims, resulting in overpayments of $42,000. These overpayments occurred primarily because the hospital did not have adequate controls to prevent incorrect billing of Medicare claims within the selected risk areas that contained errors.
View the report.
Medicare Compliance Review of Christian Hospital for 2012 and 2013
On July 12, the OIG posted a report stating that Christian Hospital, in Saint Louis, complied with Medicare billing requirements for 95 of the 199 outpatient and inpatient claims reviewed. However, the hospital did not fully comply with Medicare billing requirements for the remaining 104 claims, resulting in overpayments of $341,000 for calendar years 2012 and 2013. Specifically, 89 outpatient claims had billing errors, resulting in overpayments of almost $280,000, and 15 inpatient claims had billing errors, resulting in net overpayments of almost $62,000. 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.
NCA for hyperbaric oxygen (HBO) therapy (Section C, Topical Oxygen)
On July 12, CMS accepted a reconsideration request to remove the coverage exclusion of Continuous Diffusion of Oxygen Therapy from NCD Manual 20.29, Section C. In light of this NCD reconsideration request, CMS is reconsidering section C in NCD 20.29 (Topical Application of Oxygen). The focus of the reconsideration request will be regarding the clinical efficacy of topical oxygen. CMS is not reconsidering any other section of the NCD.
View the NCD webpage.
Security at Advisory Panel on Hospital Outpatient Payment (HOP Panel) meeting
On July 13, CMS posted a notice on the HOP Panel webpage stating that foreign nationals visiting any CMS facility require prior approval. In addition to registering for the meeting, foreign nationals must also send a separate email to APCPanel@cms.hhs.gov prior to the close of registration to request authorization to attend as a foreign national. Additionally, the Real ID Act, enacted in 2005, establishes minimum standards for the issuance of state-issued driver’s licenses and identification (ID) cards. It prohibits federal agencies from accepting an official driver’s license or ID card from a state unless the Department of Homeland Security determines that the state is in compliance with the Real ID Act. The following states/territories are not in compliance: American Samoa, Louisiana, Minnesota, New Hampshire, and New York. Beginning October 10, 2015, photo IDs (such as a driver’s license) issued by one of these states or territories will not be accepted as identification to enter federal buildings. Consequently, CMS visitors from these states/territories will need to provide alternative proof of identification (such as a passport) to gain entrance into the Baltimore-based CMS buildings.
View the HOP Panel webpage.
Proposed collection, comment request
On July 15, CMS posted a notice in the Federal Register stating that it is accepting comments on CMS–339, Provider Cost Report Reimbursement Questionnaire; CMS–460, Medicare Participation Agreement for Physicians and Suppliers. Comments are due September 13.
View the notice in the Federal Register.
Leave a comment.
Announcement of requirements and registration for the Merit-based Incentive Payment System (MIPS) Mobile Challenge; Deadline extension
On July 15, CMS posted a notice in the Federal Register launching a challenge related to the new MIPS program, which will assist CMS in accelerating the transition from the traditional fee-for-service payment model to a system that rewards health care providers for providing better care, not just more care. This challenge will address one of the most important aspects of the agency’s programs, which is educating and providing outreach to the potential hundreds of thousands of MIPS eligible clinicians.
View the notice in the Federal Register.
Upcoming lower extremity chronic venous disease MEDCAC meeting
On July 15, CMS posted the agenda, roster and speakers list for the July 20 Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) meeting. CMS also posted presentations (A-L , M-Z ) and written comments regarding this meeting.
View the webpage for the lower extremity chronic venous disease MEDCAC meeting.