This week in Medicare updates–09/07/2016
Annual Clotting Factor Furnishing Fee update 2017
On August 26, CMS released an annually recurring change request announcing the update to the Clotting Factor Furnishing Fee.
Effective date: January 1, 2017
Implementation date: January 3, 2017
View Transmittal R3607CP.
View MLN Matters article MM9789.
2017 HCPCS annual update reminder
On August 26, CMS released a recurring update notification of the HCPCS file. The file contains existing, new, revised, and discontinued HCPCS codes for 2017. This update applies to Chapter 23, section 20 of the Medicare Claims Processing Manual.
Effective date: January 1, 2017
Implementation date: January 3, 2017
View Transmittal R3606CP.
Claim Status Category and Claim Status Codes update
On August 26, CMS released a change request to update, as needed, the Claim Status and Claim Status Category Codes used for the Accredited Standards Committee (ASC) X12 276/277 Health Care Claim Status Request and Response and ASC X12 277 Health Care Claim Acknowledgment transactions. This recurring update notification can be found in Chapter 31, Medicare Claims Processing Manual, section 20.7.
Effective date: January 1, 2017
Implementation date: January 3, 2017
View Transmittal R3599CP.
View MLN Matters article MM9680.
Implement Operating Rules-Phase III ERA EFT: CORE 360 Uniform Use of Claim Adjustment Reason Codes (CARC), Remittance Advice Remark Codes (RARC) and Claim Adjustment Group Code (CAGC) Rule - Update from Council for Affordable Quality Healthcare (CAQH) Committee on Operating Rules for Information Exchange (CORE)
On August 26, CMS released a change request to instruct the contractors and Shared System Maintainers (SSM) to update systems based on the CORE 360 Uniform Use of CARC, RARC, and CAGC Rule publication. These system updates are based on the CORE Code Combination List to be published on or about October 1, 2016.This recurring update notification applies to Chapter 22, Medicare Claims Processing Manual, section 80.2.
Effective date: January 1, 2017
Implementation date: January 3, 2017
View Transmittal R3604CP.
View MLN Matters article MM9766.
Adding a foreign language tagline sheet to Medicare Summary Notices (MSN)
On August 26, CMS released a change request stating it is requiring the MACs add a new last page to the Medicare Summary Notices (MSN) which will contain foreign language taglines, in 15 different languages. This change is required by the Final Rule for Section 1557 of the Nondiscrimination Provision of the Affordable Care Act. Implementation must occur 60 days after issuance.
Effective date: This change request is issued in conjunction with modification to the MAC contracts
Implementation date: October 28, 2016
View Transmittal R1710OTN.
October 2016 update of the Ambulatory Surgical Center (ASC) payment system
On August 26, CMS released a recurring update notification updating the payment/billing policies and instructions for the October 2016 quarter of the ASC payment system.
Effective date: October 1, 2016
Implementation date: October 3, 2016
View Transmittal R3601CP.
View MLN Matters article MM9773.
2017 annual update of HCPCS codes for SNF Consolidated Billing (CB)
On August 26, CMS released a transmittal with changes to HCPCS codes and Medicare Physician Fee Schedule designations, to be used to revise CWF edits to allow A/B MACs to make appropriate payments in accordance with policy for SNF CB in Chapter 6, Medicare Claims Processing Manual, Section 110.4.1 for A/B MACs (B) and Chapter 6, Medicare Claims Processing Manual, Section 20.6 for A/B MACs (A).
Effective date: January 1, 2017
Implementation date: January 3, 2017
View Transmittal R3603CP.
View MLN Matters article MM9735.
Healthcare Provider Taxonomy Codes (HPTC) October 2016 code set update
On August 26, CMS released a transmittal stating affected Medicare contractors shall obtain the most recent HPTCs code set and use it to update their internal HPTC tables and/or reference files. The attached recurring update notification applies to the Chapter 24, Medicare Claims Processing Manual, section 60.6.
Effective date: October 1, 2016
Implementation date: January 3, 2017 -Contractors with the capability to do so shall implement this CR effective October 1, 2016.
View Transmittal R3597CP.
View MLN Matters article MM9659.
October quarterly update for 2016 DME, prosthetics, orthotics, and supplies (DMEPOS) fee schedule
On August 26, CMS released a transmittal to serve as quarterly update process for the DMEPOS fee schedule. The DMEPOS fee schedule is updated on a quarterly basis, when necessary, to implement fee schedule amounts for new codes and correct any fee schedule amounts for existing codes. It is located in Pub. 100-04, Medicare Claims Processing Manual, Chapter 23, section 60.
Effective date: October 1, 2016
Implementation date: October 3, 2016
View Transmittal R3598CP.
View MLN Matters article MM9756.
Frequently asked questions (FAQ) on the JW modifier: Drug/biological amount discarded/not administered to any patient
On August 26, CMS posted a FAQ document regarding use of the JW modifier.
View the FAQ document.
Correction to inpatient rehabilitation facility PPS for federal FY 2017
On August 31, CMS posted a notice in the Federal Register correcting typographical errors in the final rule that appeared in the August 5 Federal Register entitled, “Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2017.” The final rule published August 5 (81 FR 52056 through 52141) is corrected as of August 30.
View the notice in the Federal Register.
CMS posts regional office rural health coordinators contact information
On August 31, CMS posted a list of who to contact for rural health at all the regional offices, and their contact information including name, email, and phone number.
View the list.
Overview of the SNF value-based purchasing (VBP) program
On September 1, CMS released a special edition MLN Matters article regarding the SNF VBP program. Beginning October 1, 2018, SNFs will have an opportunity to receive incentive payments based on performance on the specified quality measure.
View MLN Matters article SE1621.
Duplicate post-payment claim reviews
On September 2, CMS released a change request to prevent Medicare post-payment claims review contractors from performing duplicative claims reviews.
Effective date: November 4, 2016
Implementation date: November 4, 2016
View Transmittal R674PI.
Submission for OMB review, comment request
On September 2, 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–10148, HIPAA Administrative Simplification Complaint Form. Comments are due October 3.
View the notice in the Federal Register.
Leave a comment.