This week in Medicare updates–09/28/2016
Privacy Act of 1974
On September 20, CMS posted a notice in the Federal Register republishing in its entirety to correct the expiration date published in the heading of the notice at 81 FR, 8075, February 17, 2016. The expiration date should read October 2, 2017, instead of October 2, 2016. In accordance with the requirements of the Privacy Act of 1974, as amended, this notice announces the re-establishment of a CMP that CMS plans to conduct with the IRS.
View the notice in the Federal Register.
View the notice in the Federal Register.
OIG levies largest penalty under a CIA against nation's biggest provider of post-acute care
On September 20, the OIG announced that Kindred Health Care, Inc., the nation's largest provider of post-acute care, including hospice and home health services, has paid a penalty of more than $3 million for failing to comply with a CIA with the federal government. It is the largest penalty for violations of a CIA to date, the OIG said.
View the story.
Medicare Compliance Review of North Carolina Baptist Hospital for claims paid from January 1, 2013, through August 31, 2014
On September 20, the OIG reported North Carolina Baptist Hospital, located in Winston-Salem, North Carolina, complied with Medicare billing requirements for 209 of the 246 inpatient claims reviewed. However, the hospital did not fully comply with Medicare billing requirements for the remaining 37 claims, resulting in net overpayments of approximately $221,000 for the audit period. On the basis of the OIG’s sample results, it estimated that the hospital received overpayments of at least $1.4 million for the audit period. 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.
Moving Medicare Advantage and Part D forward
On September 22, CMS posted a fact sheet and press release regarding the Medicare Advantage and Part D programs, including the release of data and the 2017 plan landscape for the programs.
View the fact sheet.
View the press release.
Reporting of all Recovery Auditor-initiated claim adjustments and subsequent adjustments for Periodic Interim Payment (PIP) facilities
On September 22, CMS rescinded Transmittal 1697, dated August 5, and replaced it with Transmittal 1720 to make explicit that this change request is limited to '11H' TOB. All other information remains the same. The original change request was to ensure that Recovery Auditor-initiated adjustments to PIP claims and their subsequent adjustments are accurately recorded on the Provider Statistical & Reimbursement report.
Effective date: January 1, 2017
Implementation date: January 3, 2017
View Transmittal R1720OTN.
Update to hepatitis B deductible and coinsurance and screening pap smears claims processing information
On September 22, CMS released a change request updating language regarding coinsurance and deductible for hepatitis B in Pub. 100-04, Medicare Claims Processing Manual, Chapter 18, section 10. In addition, this change request removes sub-section D in sections 30.8 and 30.9.
Effective date: December 27, 2016
Implementation date: December 27, 2016
View Transmittal R3615CP.
Changes to the laboratory NCD edit software for January 2017
On September 23, CMS released a transmittal announcing the changes that will be included in the January 2017 quarterly release of the edit module for clinical diagnostic laboratory services.
Effective date: October 1, 2016
Implementation date: January 3, 2017
View Transmittal R3614CP.
Affordable Care Act Bundled Payments for Care Improvement initiative: Recurring File Updates Models 2 and 4 January 2017 updates
On September 23, CMS released a change request to update the participating hospital files, episodes, and prospective bundled payment amounts associated with the Bundled Payments for Care Improvement initiative, Model 2 and Model 4. The number for this recurring update is R11762Q.
Effective date: January 1, 2017
Implementation date: January 3, 2017
View Transmittal R156DEMO.
Provider Reimbursement Manual: Part 1 Chapter 22, Determination of Cost of Services to Beneficiaries
On September 23, CMS released a change request updating Section 2231, Regional Medicare Swing-Bed Rates. This update adds Table 28 to update the Medicare Payment Rates for routine SNF-type services by swing-bed hospitals during calendar year 2017. These rates should be used to carve out swing-bed costs on the hospital cost report.
New/revise material effective date: For services furnished on or after January 1, 2017
View Transmittal R472P122.
Adjustment to the amount in controversy (AIC) threshold amounts for calendar year (CY) 2017 for Medicare appeals
On September 23, CMS posted a notice in the Federal Register announcing the annual adjustment in the AIC threshold amounts for ALJ hearings and judicial review under the Medicare appeals process. The adjustment to the AIC threshold amounts will be effective for requests for ALJ hearings and judicial review filed on or after January 1, 2017. The CY 2017 AIC threshold amounts are $160 for ALJ hearings and $1,560 for judicial review.
View the notice in the Federal Register.
OIG Advisory Opinion No. 16-09
On September 23, the OIG posted a response to a request for an advisory opinion regarding a proposal to install a computerized point-of-care vaccine storage and dispensing system in physicians’ offices for the physicians’ use. Specifically, it addresses whether this proposed arrangement would constitute grounds for the imposition of sanctions under the federal anti-kickback statute.
View the opinion.