This week in Medicare updates – 10/07/2015
October 2015 update of the ASC payment system
On September 25, CMS released a recurring update notification updating HCPCS, ASC billing instructions and payment policies related to Chapter 14, section 10 of the Medicare Claims Processing Manual.
Effective date: October 1, 2015
Implementation date: October 5, 2015
View Transmittal R3361CP.
Postpayment review requirements
On September 25, CMS released a change request to provide instructions to MACs on counting the 60 day time period for review of claims.
Effective date: October 26, 2015
Implementation date: October 26, 2015
View Transmittal R613PI.
CMS proposes new Medicare clinical diagnostic laboratory tests fee schedule
On September 25, CMS posted a press release announcing its next step in implementing the Protecting Access to Medicare Act of 2014 (PAMA), requiring clinical laboratories to report on private insurance payment amounts and volumes for lab tests. This data will be used to determine Medicare’s payment for lab tests beginning January 1, 2017.
On October 1, CMS posted a proposed rule in the Federal Register that would significantly revise the Medicare payment system for clinical diagnostic laboratory tests and would implement other changes required by section 216 of PAMA. Comments are due by November 24.
View the press release.
View the proposed rule in the Federal Register.
Leave a comment.
Part D Enhanced Medication Therapy Management (MTM) model
On September 28, CMS posted a fact sheet announcing the Part D Enhanced MTM model. This Enhanced MTM model offers an opportunity and financial incentives for basic stand-alone Part D Prescription Drug Plans in selected regions to offer innovative MTM programs in lieu of the standard CMS MTM model, aimed at improving the quality of care while also reducing costs.
View the fact sheet.
View the press release.
Inappropriate payments and questionable billing for Medicare Part B ambulance transports
On September 29, the OIG posted a report stating it identified both improper payments for ambulance transports and questionable billing by ambulance suppliers. The OIG found that Medicare paid $24 million in the first half of 2012 for ambulance transports that did not meet certain program requirements to justify payment.
View the report.
Better Care, Smarter Spending, Healthier People: Improving our healthcare delivery system
On September 29, CMS posted a fact sheet regarding efforts to improve the healthcare delivery system. It states that tremendous progress has been made to transform our system into one that rewards value of care delivered versus volume, strengthens delivery of care through greater integration and coordination, and has resulted in fewer unnecessary hospital readmissions, reductions in healthcare-associated infections and hospital-acquired conditions, and improvements in quality outcomes and cost efficiency.
View the fact sheet.
Transforming Clinical Practice Initiative awards
On September 29, CMS posted a fact sheet stating it awarded $685 million to 39 national and regional collaborative healthcare transformation networks and supporting organizations to provide technical assistance support to help equip more than 140,000 clinicians with tools and support needed to improve quality of care, increase patients’ access to information, and spend dollars more wisely.
View the fact sheet.
CMS should use targeted tactics to curb questionable and inappropriate payments for chiropractic services
On September 30, the OIG posted a report stating that, in 2013, $76 million in Medicare payments for chiropractic services were questionable. Almost half of the questionable payments were for claims suggestive of maintenance therapy. In addition, just 2% of chiropractors were responsible for half of the questionable payments. Medicare inappropriately paid $21 million for chiropractic services that lacked a primary diagnosis covered by Medicare.
View the report.
OIG states Medicare payment system for SNF should be reevaluated
On September 30, the OIG posted a report stating that, along with other entities, it has raised longstanding concerns regarding Medicare's SNF payment system. These concerns focus on SNF billing, the method of paying for therapy, and the extent to which Medicare payments exceed SNFs' costs. In a study, the OIG found that Medicare payments for therapy greatly exceeded SNFs' costs for therapy and that under the current payment system, SNFs increasingly billed for the highest level of therapy even though key beneficiary characteristics remained largely the same. Increases in SNF billing-particularly for the highest level of therapy-resulted in $1.1 billion in Medicare payments in FYs 2012 and 2013.
View the report.
October calendar year (CY) 2015 quarterly update to the Medicare Physician Fee Schedule Database
On September 29, CMS rescinded Transmittal 3317, dated August 6, 2015, and replaced it with Transmittal 3364 to provide clarity to the CWF instructions and 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 R3364CP.
View revised MLN Matters article MM9266.
Correction to update of Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) for FY beginning October 1, 2014 (FY 2015)
On October 1, CMS posted a notice in the Federal Register correcting technical errors that appeared in the final rule published in the Federal Register on August 6, 2014 entitled “Inpatient Psychiatric Facilities Prospective Payment System—Update for Fiscal Year Beginning October 1, 2014 (FY 2015); Final Rule.” The change is effective October 1.
View the notice in the Federal Register.
Request for information regarding implementation of the Merit-based Incentive Payment System (MIPS), Promotion of Alternative Payment Models, and Incentive Payments for Participation in Eligible Alternative Payment Models
On October 1, CMS posted a request for information in the Federal Register stating Section 101 of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) repeals the Medicare sustainable growth rate methodology for updates to the physician fee schedule (PFS) and replaces it with a new MIPS for MIPS eligible professionals under the PFS. Section 101 of the MACRA sunsets payment adjustments under the current Physician Quality Reporting System (PQRS), the Value-Based Payment Modifier (VM), and the EHR Incentive Program and consolidates aspects of the PQRS, VM, and EHR Incentive Program into the new MIPS. CMS is seeking public and stakeholder input to inform our implementation of these provisions. Comments are due by November 2.
View the request for information in the Federal Register.
Leave a comment.
National Government Services, Inc., (NGS) did not always refer Medicare cost reports and reconcile outlier payments
On October 1, the OIG posted a report stating that, of 80 Medicare-participating hospital cost reports with outlier payments that qualified for reconciliation, 23 cost reports had unreliable cost-to-charge ratios (CCR) because cost report data may not have accurately reflected the actual CCR. Of the 57 remaining cost reports, NGS referred 35 cost reports to CMS in accordance with Federal guidelines. However, NGS did not refer 22 cost reports that should have been referred to CMS for reconciliation. Of these, 10 cost reports had not been settled and should have been referred to CMS for reconciliation. The OIG calculated that the financial impact to Medicare of the unreconciled outlier payments associated with 8 of these 10 cost reports was approximately $19.7 million. It also calculated that approximately $2.9 million was due from Medicare to the providers for the two other cost reports that should have been referred to CMS for reconciliation.
View the report.
Final decision for NCDs proposed for removal
On October 1, CMS posted a memorandum detailing NCDs that had been proposed for removal in March 2015. Decisions were made after comment period. One NCD that was proposed for removal is being removed and one is not being removed at this time.
View the final decision memorandum.
Announcement of the Advisory Panel on Clinical Diagnostic Laboratory Tests
On October 2, CMS posted a notice in the Federal Register announcing the next meeting date of the Advisory Panel on Clinical Diagnostic Laboratory Tests on Monday, October 19. The purpose of this panel is to advise the secretary of the HHS and the administrator of CMS on issues related to clinical diagnostic laboratory tests. Registration for in-person attendance must be completed by October 13. One can also view a webcast of the meeting or listen to a telecast.
View the notice in the Federal Register.
http://www.gpo.gov/fdsys/pkg/FR-2015-10-02/pdf/2015-25162.pdf