This week in Medicare updates–10/12/2016
October 2016 Medicare Quarterly Provider Compliance Newsletter Released
CMS has released its October 2016 Medicare Quarterly Provider Compliance Newsletter, Volume 7, Issue 1. Topics include Comprehensive Error Rate Testing (CERT) review of Transluminal Balloon Angioplasty, Venous; Endovenous Ablation Therapy of Incompetent Vein; Blepharoplasty; and Transurethral Resection of the Prostate. In addition, Recovery Auditor findings regarding Post-Acute Care Transfer and Skilled Nursing Facility (SNF) Coding Validation are discussed.
View the newsletter.
OIG Reports on Medicare Payments for Clinical Diagnostic Laboratory Tests
On October 3, 2016, the OIG released two reports on studies regarding Medicare Payments for Clinical Diagnostic Laboratory Tests, “Medicare Payments for Clinical Diagnostic Laboratory Tests in 2015: Year 2 of Baseline Data” and “Changing How Medicare Pays for Clinical Diagnostic Laboratory Tests: An Update on CMS's Progress.” In response to a Protecting Access to Medicare Act of 2014 (PAMA) mandate to reform Medicare's payment system for lab tests, the OIG is monitoring Medicare payments for lab tests and CMS's implementation of the new payment system for 2018.
View the reports.
OIG Early Alert Released on Early Incorporating Medical Device-Specific Information on Claim Forms
On October 3, 2016, the OIG alerted CMS to the preliminary results of its ongoing review of the costs Medicare incurred because of recalled or defective medical devices. The review showed that the lack of medical device-specific information in the claims data impedes CMS’ ability to effectively identify and track total costs related to the replacement of recalled or defective devices.
View the alert.
Reform of Requirements for Long-Term Care Facilities
On October 4, 2016, CMS issued a Final Rule entitled “Medicare and Medicaid Programs; Reform of Requirements for Long-Term Care Facilities” in the Federal Register. The rule revises requirements for long-term care facilities participating in the Medicare and Medicaid programs.
The changes reflect substantial advances made in the past several years in the theory and practice of service delivery and safety. The revisions are also an integral part of CMS’ efforts to achieve broad-based improvements both in healthcare quality furnished through federal programs and patient safety, while at the same time reducing procedural burdens on providers.
Effective date: November 28, 2016.
Implementation dates:
Phase 1: November 28, 2016.
Phase 2: November 28, 2017.
Phase 3: November 28, 2019.
View the Federal Register.
View the Survey and Certification Letter memorandum.
Corrections to Hospital IPPS for Acute Care Hospitals and the LTCH PPS and Policy Changes and FY 2017 Rates
On October 5, 2016, CMS issued corrections to the FY2017 IPPS final rule in the Federal Register. It corrects technical and typographical errors that appeared in the final rule. The errors caused a correction to the Operating and Capital Standardized Amounts, Wage Indices, Outlier Threshold and other factors which will affect payment rate calculations for FY2017. The correction notice also contains many coding corrections.
Effective date: October 1, 2016
View the Federal Register.
Medicare Improperly Paid Providers Millions of Dollars for Incarcerated Beneficiaries Who Received Services During 2013 and 2014
On October 7, 2016, the OIG released a report, “Medicare Improperly Paid Providers Millions of Dollars for Incarcerated Beneficiaries Who Received Services During 2013 and 2014,” which found that CMS’ existing and planned revisions to its policies and procedures ensuring that payments are not made for Medicare services rendered to incarcerated beneficiaries did not comply with Medicare requirements.
View the report.