This week in Medicare updates–11/11/2015
Manual updates to clarify IRF claims processing
On October 30, CMS released a change request to update Pub. 100-04, Medicare Claims Processing Manual, Chapter 3, to clarify key components of IRF payment policies. These changes are intended only to clarify the existing policies and no system or processing changes are anticipated.
Effective date: December 2, 2015
Implementation date: December 2, 2015
View Transmittal R3388CP.
View MLN Matters article MM9362.
Revised hospital guidance for pharmaceutical services and expanded guidance related to compounding of medications
On October 30, CMS posted a survey and certification letter regarding an updated State Operations Manual (SOM) Appendix A with respect to both the hospital survey process and the interpretive guidelines for the pharmaceutical services CoP.
View the survey and certification letter.
FY 2016 Work Plan
On November 2, the OIG posted its FY 2016 Work Plan on its website. The Work Plan includes projects planned in each of the Department's major entities
View the FY 2016 Work Plan.
Bipartisan Budget Act of 2015: Off-campus department provisions
On November 2, President Obama signed the Bipartisan Budget Act of 2015, which included significant changes to the payment for off-campus provider-based departments of hospitals. Section 603 of the new law excludes services for off-campus provider-based departments from the services payable under OPPS and instead allows payment under other applicable payment systems. The provision includes a “grandfather” clause for departments that were billing as provider-based under the OPPS prior to the date of enactment and a delay in implementation until January 2017.
View the Act.
Written Orders Prior to Delivery (WOPD)
On November 3, CMS rescinded Transmittal 618, dated October 9, 2015, and replaced it with Transmittal 623 to delete sections 5.2.3.1 through 5.2.3.2.3 as this information has been reorganized to sections 5.2.4 through 5.2.5.2. All other information remains the same. The original transmittal provided new instructions for WOPD for power operated vehicles, power wheelchairs, and certain covered DME items.
Effective date: November 10, 2015
Implementation date: November 10, 2015
View Transmittal R623PI.
Revisions to requirements for discharge planning for hospitals, critical access hospitals (CAH), and HHAs
On November 3, CMS posted a proposed rule in the Federal Register that would revise the discharge planning requirements that hospitals, including long-term care hospitals and inpatient rehabilitation facilities, CAHs, and HHAs, must meet in order to participate in the Medicare and Medicaid programs. The proposed rule would also implement the discharge planning requirements of the Improving Medicare Post-Acute Care Transformation Act of 2014. Comments are due January 4, 2016.
View the proposed rule in the Federal Register.
View the press release.
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Oncology Care Model (OCM) Monthly Enhanced Oncology Services (MEOS) payment implementation
On November 5, CMS released a change request for the purpose of establishing the necessary systems' changes to implement the MEOS Payments for the OCM.
Effective date: April 1, 2016
Implementation date: April 4, 2016
View Transmittal R127DEMO.
Implementation instructions to operationally process the claims of a Subclause (II) long term care hospital (LTCH) in a manner consistent with the claims processing of non-PPS hospitals
On November 5, CMS released a change request to implement changes necessary to operationally process the claims of a subclause (II) LTCH in a manner that is generally consistent with the claims processing of non-PPS hospitals (i.e., TEFRA hospitals). This would make the per discharge claim payment amounts more commensurate with their actual payments at cost report settlement under the LTCH PPS payment adjustment at §412.526.
Effective date: January 1, 2016
Implementation date: April 4, 2016
View Transmittal R3394CP.