The week in Medicare updates
Medically Unlikely Edits (MUE) and Bilateral Procedures
On June 30, CMS released MLN Matters article SE1422 stating that claims filed using noncompliant coding for bilateral surgical procedures may have been paid in the past. The purpose of this article is to inform providers that MUE changes may now render those claim lines unpayable. CMS is converting most MUEs into per day edits and the MUE Adjudication Indicator indicates the type of MUE and its basis. Effective with the July 1 update, published per day edits are identified on the CMS NCCI website.
View MLN Matters article SE1422.
Provider notice on MAC website
On July 3, CMS issued a change request to require MACs to post-review issues to their websites. It also requires that the Supplemental Medical Review Contractor maintain a public website that displays what types of issues are under review.
Effective date: September 5, 2014
Implementation date: September 5, 2014
View Transmittal R527PI.
Proposed changes for the Physician Value-based Payment Modifier in the CY 2015 Medicare Physician Fee Schedule Proposed Rule
On July 3, CMS issued a proposed rule that would update payment policies and payment rates for services furnished under the Medicare Physician Fee Schedule (MPFS) on or after January 1, 2015. The proposed rule includes proposals for implementing the value-based payment modifier (Value Modifier) required by the Affordable Care Act that would adjust payments to physicians, groups of physicians, and other eligible professionals based on the quality and cost of care they furnish to beneficiaries enrolled in the traditional FFS program.
View the fact sheet.
Rehabilitation Agencies: Fire alarm systems, State Operations Manual (SOM) Appendix E Revision
On July 3, CMS released an interpretive guidance revision to clarify the fire safety requirements. Rehabilitation agencies are required to have an automatic extinguishing system or an enclosure with a one-hour fire resistance rating in hazardous areas as well as fire extinguishers, a fire alarm system, and a fire evacuation plan. Air horns will not serve in place of a fire alarm system for rehabilitation agencies. Rehabilitation agencies cannot be certified or recertified and extension locations cannot be approved if they do not meet the minimum fire protection requirements.
View the survey and certification letter.
Revisions to SOM, Appendix PP–Guidance to Surveyors for Long-Term Care (LTC) Facilities and Chapter 4
On July 3, CMS revised the Interpretive Guidelines and, where appropriate, Investigative Protocols for the following F Tags to incorporate Survey & Certification policy memos issued from October 2003 through May 2014. Section 4132.1E Waiver of Program Prohibition has been revised to incorporate information consistent with CFR 483.151(c)(1). Section 4542.2 State Agency (SA) Expenses for Training of SA Personnel has been revised to include Association of Health Facility Survey Agencies to the list of annual meetings.
View the survey and certification letter.
Medicare signature Requirements
On July 7, CMS released MLN Matters article SE1419 stating that Medicare requires services provided/ordered be authenticated by the author. The method used should be a handwritten or electronic signature. Under certain circumstances, a rubber stamped signature is acceptable. If you do not have an acceptable signature on services provided/ordered, your Medicare payment may be impacted.
View MLN Matters article SE1419.
CY 2015 home health prospective payment system (HH PPS) rate update
On July 7, CMS posted a proposed rule in the Federal Register that would update the HH PPS rates, effective January 1, 2015. Updates include the standardized 60-day episode payment and per-visit rates, and the non-routine medical supply conversion factor. This rule implements the second year of the four-year phase-in of the rebasing adjustments to the HH PPS payment rates, and provides information on efforts to monitor the potential impacts of the rebasing adjustments and mandated face-to-face encounter requirement. It also contains changes to simplify the face-to-face encounter regulatory requirements. It also discusses coverage of insulin injections under the HH PPS, the delay in the implementation of ICD-10-CM, and solicits comments on a home health value-based purchasing model. Comments are due September 2.
View the notice in the Federal Register.
View the fact sheet.
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Questionable billing for Medicare Part B clinical laboratory services
On July 8, OIG posted a report regarding a study on billing for clinical laboratory services. In 2010, more than 1,000 labs exceeded the thresholds (i.e., had unusually high billing) for five or more measures of questionable billing for Medicare lab services.
View the report.
Proposed update to End-Stage Renal Disease (ESRD) PPS, Quality Incentive Program, and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DME POS)
On July 11, CMS posted a proposed rule in the Federal Register that would update and make revisions to the ESRD PPS for CY 2015. It also proposes to set forth requirements for the ESRD quality incentive program, including payment years 2017 and 2018. This rule also proposes a technical correction to remove outdated terms and definitions. It also proposes changes to the DMEPOS fee schedule payment amounts and regulations. Comments are due September 2.
View the notice in the Federal Register.
View the fact sheet regarding ESRD quality measures.
View the fact sheet regarding ESRD PPS and DME POS policies.
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Revisions to payment policies under Medicare Part B for CY 2015
On July 11, CMS posted revisions to address changes to the physician fee schedule and other Medicare Part B payment policies to ensure its payment systems are updated to reflect changes in medical practice and the relative value of services, as well as changes in the statute. See the Table of Contents for a listing of the specific issues addressed in this proposed rule. Comments are due September 2.
View the notice in the Federal Register.
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