This week in Medicare updates–11/25/2015
New influenza virus vaccine code
On November 9, CMS released a transmittal providing instructions for payment and CWF edits to be updated to include influenza virus vaccine code 90630 (Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intradermal use) for claims with dates of service on or after August 1, 2015, processed on or after April 4, 2016.
Effective date: August 1, 2015
Implementation date: December 11, 2015, for requirement 9357.7; April 4, 2016, for all other requirements
View Transmittal R3403CP.
Selecting home health claims for Probe and Educate Review
On November 9, CMS released a special edition MLN Matters article for HHAs submitting claims to MACs for home health services provided to Medicare beneficiaries. It contains a summary of the technical direction that CMS will issue to the MACs regarding the Additional Documentation Requests that the MACs will be sending for the first round of claim reviews.
View special edition MLN Matters article SE1524.
New waived tests
On November 13, CMS released a recurring update notification informing contractors of 19 new CLIA waived complexity tests approved by the FDA. This recurring update notification applies to Chapter 16, Medicare Claims Processing Manual, section 70.8 of the IOM.
Effective date: January 1, 2016
Implementation date: January 4, 2016
View Transmittal R3406CP.
View MLN Matters article MM9416.
Revisions to payment policies under the physician fee schedule and other revisions to Part B for CY 2016
On November 16, CMS posted the final rule with comment period addressing changes to the physician fee schedule, and other Medicare Part B payment policies, to ensure that the payment systems are updated to reflect changes in medical practice and the relative value of services, as well as changes in the statute.
View the final rule in the Federal Register.
Leave a comment.
CY 2016 Part A premiums for the uninsured aged and for certain disabled individuals who have exhausted other entitlement
On November 16, CMS posted an annual notice in the Federal Register announcing Medicare’s Hospital Insurance (Part A) premium for uninsured enrollees in CY 2016. This premium is paid by enrollees age 65 and over who are not otherwise eligible for benefits under Medicare Part A and by certain disabled individuals who have exhausted other entitlement. The monthly Part A premium for the 12 months beginning January 1, 2016, for these individuals will be $411. The premium for certain other individuals as described in this notice will be $226.
View the notice in the Federal Register.
CY 2016 inpatient hospital deductible and hospital and extended care services coinsurance amounts
On November 16, CMS posted a notice in the Federal Register announcing the inpatient hospital deductible and the hospital and extended care services coinsurance amounts for services furnished in CY 2016 under Medicare Part A. For CY 2016, the inpatient hospital deductible will be $1,288. The daily coinsurance amounts for CY 2016 will be: (1) $322 for the 61st through 90th day of hospitalization in a benefit period; (2) $644 for lifetime reserve days; and (3) $161.00 for the 21st through 100th day of extended care services in a skilled nursing facility in a benefit period.
View the notice in the Federal Register.
Medicare Part B monthly actuarial rates, premium rate, and annual deductible beginning January 1, 2016
On November 16, CMS posted a notice in the Federal Register announcing the monthly actuarial rates for aged (age 65 and over) and disabled (under age 65) beneficiaries enrolled in Part B of the Medicare Supplementary Medical Insurance program beginning January 1, 2016.
View the notice in the Federal Register.
Comprehensive Care for Joint Replacement (CJR) Model
On November 16, CMS posted a fact sheet regarding the CJR Model.
View the fact sheet.
Waivers for special arrangements involving Comprehensive (CJR) Model participants
On November 16, the OIG and CMS jointly issued waivers for specified arrangements involving CJR Model participants. See the Innovation Center’s page for additional information on the Comprehensive Care for Joint Replacement Model.
View the update.
Update to the list of revisions on the October CY 2015 quarterly update to the Medicare physician fee schedule database (MPFSDB)
On November 18, CMS rescinded Transmittal 3364, dated September 29, 2015, and replaced it with Transmittal 3407 to update the list of revisions on the attachment. All other information remains the same.
Effective date: January 1, 2015
Implementation date: October 5, 2015
View Transmittal R3407CP.
Changes to transmittal regarding chronic care management (CCM) services for rural health clinics (RHC) and federally qualified health centers (FQHC)
On November 18, CMS rescinded Transmittal 1530, dated August 6, 2015, and replaced it with Transmittal 1576 because it is no longer sensitive/controversial. This transmittal also adds a provider education requirement and updated references to the Physician Fee Schedule Proposed and Final Rules. All other information remains the same.
Effective date: January 1, 2015
Implementation date: October 5, 2015
View Transmittal R1576OTN.
Clarification of patient discharge status codes and hospital transfer policies
On November 18, CMS released a revised special edition MLN Matters article. It provides clarifications and instructions on determining the correct patient discharge status code to use when completing your claims. The revision is to clarify language on pages 2 and 3 and to add a reference to MLN Matters® article SE1411. The link to SE1411 was previously removed until it could be updated. All other information remains the same.
View special edition MLN matters article SE0801.
Request for information to aid in the design and development of a survey regarding patient and family experiences with care received in long-term care hospitals
On November 20, CMS posted a request for information in the Federal Register to aid in the design and development of a survey regarding patient and family member experiences with the care received in long-term care hospitals. Comments are due by January 19, 2016.
View the notice in the Federal Register.
Leave a comment.
Request for information to aid in the design and development of a survey regarding patient and family experiences with care received in inpatient rehabilitation facilities
On November 20, CMS posted a request for information in the Federal Register to aid in the design and development of a survey regarding patient and family member experiences with the care received in inpatient rehabilitation facilities. Comments are due by January 19, 2016.
View the notice in the Federal Register.
OIG Advisory Opinion No. 15-14
On November 20, the OIG posted an advisory opinion regarding a non-profit, tax-exempt, charitable organization’s program to help financially needy patients, including Medicare and Medicaid beneficiaries, obtain magnetic resonance imaging for the diagnosis or ongoing evaluation of a disease.
View the opinion.
Release of FY 2016 ESRD Core Survey Data Worksheet
On November 20, CMS posted a survey and certification letter that has been updated for FY 2016 with current clinical indicators and corresponding national thresholds for facility comparison. CMS is providing the revised worksheet to ensure consistent administration of a standardized ESRD survey process and is requiring surveyor’s use of the ESRD Core Survey Data Worksheet for all recertification surveys of ESRD facilities.
View the survey and certification letter.