This week in Medicare updates–10/26/2016

October 25, 2016
Medicare Insider

Internet Only Manual Updates to Pub. 100-01, 100-02 and 100-04 to Correct Errors and Omissions (SNF)
On October 13, CMS posted Transmittal 228 and revised MLN Matters MM9748 to update the Medicare manuals to correct various minor technical errors and omissions. These changes clarify the existing content; no policy, processing, or system changes are anticipated.
Effective date: October 18, 2016
Implementation date: October 18, 2016
View Transmittal 228.
View MLN Matters MM9748.


Revisions to State Operations Manual (SOM) Appendix W - Survey Protocol, Regulations and Interpretive Guidelines for Critical Access Hospitals (CAH) and Swing-Beds in CAHs
On October 14, CMS posted Transmittal 163, which includes revisions to the regulation language for CAH providers of long-term care services that changed in 2004 because SOM Appendix W was not revised. The technical correction is being revised to reflect the current regulation.
Effective date: October 14, 2016
Implementation date: October 14, 2016
View the transmittal.


Ambulance Inflation Factor for CY 2017 and Productivity Adjustment
On October 14, CMS posted Transmittal 3625 and MLN Matters MM9811, which manualize the ambulance inflation factor so Medicare contractors can accurately determine payment amounts for ambulance services.
Effective date: January 1, 2017
Implementation date: January 3, 2017
View the transmittal.
View MLN Matters MM9811.


Fiscal Year 2017 Inpatient Prospective Payment System and Long-Term Care Hospital PPS Changes
On October 19, 2016, CMS rescinded Transmittal 3616, dated September 23, 2016, and replaced it with Transmittal 3626 to revise the instructions in Attachment 8, section 1, step 4a and revise the Long-Term Care Hospital (LTCH) Cost to Charge (CCR) ratio ceiling. In addition, this CR is being revised to remove the Sensitive/Controversial designation. All other information remains the same.
Effective date: October 1, 2016
Implementation date: October 3, 2016
View the transmittal.


Hundreds of Millions in Medicare Payments for Chiropractic Services Did Not Comply With Medicare Requirements
On October 19, the OIG posted a report regarding Medicare payments for chiropractic services that did not comply with Medicare requirements. The OIG estimates that $358.8 million, or approximately 82%, of the $438.1 million paid by Medicare for chiropractic services was unallowable. CMS' controls were ineffective in preventing payments for medically unnecessary chiropractic services, according to the OIG.
View the report.


Effective Date for Use of Form-CMS 10280 (HHCCN)
On October 19, CMS announced the effective date for use of Form CMS-10280 (HHCCN) as 90 days after the date of the announcement. In June 2016, the form was revised and approved by the Office of Management and Budget. The revised form, which home health agencies use to notify original Medicare beneficiaries receiving home health care benefits of plan of care changes, is available at
Effective date: 90 days after the announcement.
View the CMS website.


OIG posts four new Corporate Integrity Agreements
On October 20, the OIG posted four new Corporate Integrity Agreements (CIA) made during September and October 2016 with the following organizations:

  • CVS Health Corporation of Woonsocket, RI
  • Daybreak Venture, LLC and Daybreak Partners, LLC, of Denton, TX
  • Health Concepts, Ltd., of Providence, RI
  • Whittier Health Network, Inc., of Haverhill, MA

View the OIG update.


Hospital Compare is updated with VA hospital performance data
On October 21, CMS posted a press release regarding the inclusion of Department of Veterans Affairs (VA) hospital performance data. CMS plans to add additional VA hospital data in December with plans for future seamless integration of VA data onto the Hospital Compare website, allowing the comparison of VA and civilian acute care hospitals.
View the press release.