This week in Medicare updates–11/30/2016
Claims Status Category and Claims Status Codes Update
On November 18, CMS published Transmittal 3661 and MLN Matters 9769 to update the Claim Status and Claim Status Category Codes used for the Accredited Standards Committee (ASC) X12 276/277 Health Care Claim Status Request and Response and ASC X12 277 Health Care Claim Acknowledgment transactions.
Effective date: April 1, 2017
Implementation date: April 3, 2017
Update to Pub. 100-08, Chapter 15
On November 18, CMS published Transmittal 688, which rescinds and replaces Transmittal 659, dated June 24, 2016, to apply the overpayment collection process to Medicare Administrative Contractors (MAC) processing Part A enrollments. The correction also clarifies the overpayment process for providers/suppliers within their appeals window. Specifically, the manual instruction in section 15.27.2. has been amended to remove language related to claims filing deadlines. In addition, business requirement 9635.14 has been expanded to assign responsibility to A/B MAC Part A, and A/B MAC Part HHH.
Effective date: July 26, 2016
Implementation date: July 26, 2016
Issuing Compliance Letters to Specific Providers and Suppliers Regarding Inappropriate Billing of Qualified Medicare Beneficiaries for Medicare Cost-Sharing
On November 18, CMS published Transmittal 1757 (rescinding and replacing Transmittal 1747, dated November 4, 2016) and revised MLN Matters 9817 to clarify the effective date of the escalation process, to change the implementation date, and to revise the attachments to include minor corrections in the language to show that the Medicaid program also helps low-income beneficiaries pay their Medicare premiums.
Effective date: December 16, 2016
Implementation dates:
December 16, 2016 - For all requirements other than Provider Education
March 8, 2017 - For Provider Education
Updates for the Shared System Maintainers to implement the Social Security Number Removal Initiative
On November 23, CMS published Transmittal 1758 to request that Medicare Shared Systems Maintainers update their systems to implement changes for Social Security Number Removal Initiative.
Effective date: April 1, 2017
Implementation date: April 3, 2017
Sample Hospice Notice of Election Statement
On November 23, CMS released MLN Matters SE1631 for physicians and hospices submitting claims to Home Health & Hospice Medicare Administrative Contractors. In the September 2016 OIG report “Hospices Should Improve Their Election Statements and Certifications of Terminal Illness,” the OIG noted that hospice election statements lacked required information or had other vulnerabilities in more than one-third of general inpatient care stays. The statements did not always mention, as required, that the beneficiary was waiving coverage of certain Medicare services by electing hospice care or that hospice care is palliative rather than curative. There were also deficiencies in certifications of terminal illness required of physicians for hospice patients. This Special Edition MLN Matters article details the requirements for and provides further guidance to hospices on election statements.
Documentation Requirements for the Hospice Physician Certification/Recertification
On November 23, CMS published MLN Matters SE1628 to provide guidance on the requirements for a valid physician certification and recertification. Requirements include a written certification on file in the hospice beneficiary’s record prior to submission of a claim and clinical information and other documentation that support the medical prognosis accompanying the certification. While the clinical information may initially be provided verbally, it must be documented in the medical record and included as part of the hospice’s eligibility assessment.
New Waived Tests
On November 23, CMS released Transmittal 3666 and MLN Matters 9797 to inform contractors of 40 newly added Clinical Laboratory Improvement Amendments of 1988 (CLIA) waived tests approved by the Food and Drug Administration.
The CPT codes for the tests must have the modifier -QW to be recognized as a waived test with the exception of several tests noted in the Transmittal (i.e., CPT codes 81002, 81025, 82270, 82272, 82962, 83026, 84830, 85013, and 85651 do not require the -QW modifier to be recognized as a waived test).
Effective date: January 1, 2017
Implementation date: January 3, 2017
Reprocessing of Some IPPS Claims
On November 23, CMS released information regarding some Inpatient Prospective Payment System (IPPS) hospital and Long-Term Care Hospital (LTCH) claims with discharge dates on or after October 1, 2016, which may be grouped to an incorrect Medicare Severity - Diagnosis Related Group (MS-DRG). A revision to the ICD-10 MS-DRG version 34 software file was made and affected claims will be reprocessed by your Medicare Administrative Contractor by February 1, 2017. No action is required by IPPS and LTCH hospitals.