This week in Medicare updates–08/31/2016
Coding revisions to NCDs
On August 19, CMS released a change request serving as the ninth maintenance update of ICD-10 conversions and other coding updates specific to NCDs. The majority of the NCDs included are a result of feedback received from previous ICD-10 NCD change requests. 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: January 1, 2017, unless otherwise noted
Implementation date: January 3, 2017
View Transmittal R1708OTN.
Medicare Compliance Review of Home Health VNA for 2011 and 2012
On August 19, the OIG posted a report stating that Home Health VNA in Lawrence, Massachusetts, did not comply with Medicare billing requirements for 105 of the 497 home health claims reviewed. As a result, this agency received net overpayments of $314,000 for calendar years 2011 and 2012. Specifically, it incorrectly billed Medicare because beneficiaries were not homebound, beneficiaries did not require skilled services, documentation from the certifying physicians were missing or insufficient to support the services provided, or, in one instance, a claim contained an incorrect payment code. These errors occurred primarily because this agency did not have adequate controls to prevent the incorrect billing of Medicare claims within selected risk areas.
View the report.
Revisions to IPPS for acute care hospitals and the long-term care hospital PPS and policy changes and FY 2017 rates
On August 22, CMS posted a notice in the Federal Register stating it is revising the Medicare hospital IPPS for operating and capital-related costs of acute care hospitals to implement changes arising from its continuing experience with these systems for FY 2017. Some of these changes will implement certain statutory provisions contained in the Pathway for Sustainable Growth Reform Act of 2013, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Notice of Observation Treatment and Implications for Care Eligibility Act of 2015, and other legislation. CMS is providing the estimated market basket update to apply to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2017.
View the notice in the Federal Register.
Home health agency beneficiary notices
On August 22, CMS updated the home health agencies beneficiary rights and protections notices to Original Medicare (fee for service) beneficiaries.
View the notices.
CMS examines inappropriate steering of people eligible for Medicare or Medicaid into Marketplace plans
On August 23, CMS issued a request for information seeking public comment on concerns that some healthcare providers and provider-affiliated organizations may be steering people eligible for, or receiving, Medicare and/or Medicaid benefits into Affordable Care Act-compliant individual market plans, including Health Insurance Marketplace plans, for the purpose of obtaining higher reimbursement rates. CMS also sent letters to all Medicare-enrolled dialysis facilities and centers informing them of this announcement. Comments are due September 22.
View the notice in the Federal Register.
Leave a comment.
Revision to October quarterly update to the Medicare Physician Fee Schedule Database
On August 24, CMS rescinded Transmittal 3594, dated August 19, and replaced it with Transmittal 3595 to add the TOS for CWF for G0490 to BR 9749.6. All other information remains the same.
Effective date: January 1, 2016
Implementation date: October 3, 2016
View Transmittal R3595CP.
Medicare Accountable Care Organizations (ACO) 2015 Performance Year Quality and Financial Results
On August 25, CMS released the 2015 quality and financial performance results for Medicare ACOs that show that ACOs continue to improve the quality of care for Medicare beneficiaries, while generating financial savings.
View the fact sheet.
View the press release.