This week in Medicare updates
Extracorporeal photopheresis
On August 22, CMS released a transmittal clarifying coverage of extracorporeal photopheresis in hospital inpatient and outpatient departments for the treatment of bronchiolitis obliterans syndrome (BOS) following lung allograft transplantation only when provided under a clinical research study that meets specific requirements. The clarification addresses other coverage of extracorporeal photopheresis for other covered diagnoses, as well as coverage for BOS. CMS indicated there were no new policies provided in the transmittal, but the clarifications were necessary because of inappropriate denials.
Effective date: September 23, 2014; ICD-10: Upon implementation of ICD-10.
Implementation date: September 23, 2014
View Transmittal R3050CP.
View MLN Matters article MM8808.
New physician specialty code changes and additions
On August 22, CMS released a change request to create a new physician specialty code for Interventional Cardiology (C3) and a new non-physician specialty code for Restricted Use (C4). In addition, the changes were made to the descriptions of existing codes.
Effective date: January 1, 2015
Implementation date: January 5, 2015
View Transmittal R3048CP.
View Transmittal R238FM.
View MLN Matters article MM8812.
Reporting National Provider Identifier (NPI) on anti-markup and reference laboratory claims
On August 22, CMS released change request to provide guidance for physicians and suppliers billing anti-markup and reference laboratory claims. Physicians and other suppliers will no longer be permitted to submit their own NPI in Item 32a (or its electronic equivalent) when the performing physician or supplier is located in another jurisdiction. The changes implemented in PECOS will allow contractors the ability to verify all physician and supplier NPIs, regardless of the jurisdiction in which they are enrolled.
Effective date: January 1, 2015
Implementation date: January 5, 2015 for claims received on or after January 1, 2015
View Transmittal R3047CP.
View MLN Matters article MM8806.
October update to the CY 2014 Medicare physician fee schedule database (MPFSDB)
On August 22, CMS released a transmittal announcing the release of the October update to the Medicare physician fee schedule payment files. An attachment to the file contains changes and corrections implemented in this version of the file.
Effective date: October 1, 2014
Implementation date: October 6, 2014
View Transmittal R3046CP.
https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3046CP.pdf
View MLN Matters article MM8888.
Quarterly update to the Correct Coding Initiative (CCI) edits, version 21.0
On August 22, CMS released a transmittal announcing the release of the October quarterly update to the CCI procedure to procedure edits.
Effective date: January 1, 2015
Implementation date: January 5, 2015
View Transmittal R3044CP.
View MLN Matters article MM8781.
Inpatient rehabilitation facility (IRF) annual update: PPS Pricer changes for FY 2015
On August 22, CMS released a transmittal announcing the availability of the new IRF PRICER software package, which will contain the updated rates that are effective for claims with discharges that fall within October 1, 2014, through September 30, 2015.
Effective date: October 1, 2014
Implementation date: October 6, 2014
View Transmittal R3039CP.
View MLN Matters article MM8788.
Annual update of HCPCS codes used for home health consolidated billing enforcement
On August 22, CMS released a change request providing the annual update to the list of HCPCS codes used by Medicare systems to enforce consolidated billing of home health services.
Effective date: January 1, 2015
Implementation date: January 5, 2015
View Transmittal R3035CP.
Update to inpatient psychiatric facilities prospective payment system (IPF PPS) FY 2015
On August 22, CMS released a change request identifying changes required as part of the annual IPF PPS update from the FY 2015 IPF PPS final rule, published on August 1. These changes are applicable to IPF discharges occurring during fiscal year October 1, 2014 through September 30, 2015. This Recurring Update applies to Chapter 3, Medicare Claims Processing Manual, section 190.4.3.
Effective date: October 1, 2014
Implementation date: October 6, 2014
View Transmittal R3034CP.
View MLN Matters article MM8889.
Influenza vaccine payment allowances-annual update for 2014-2015 season
On August 22, CMS released a recurring update notification indicating that the payment allowance for the influenza vaccine for the 2014-2015 season is still pending. This payment allowance would apply to claims in August 2014.
Effective date: August 1, 2014
Implementation date: November 24, 2014
View Transmittal R3033CP.
View MLN Matters article MM8890.
ICD-10 Testing-acknowledgement testing with providers
On August 22, CMS released a change request to instruct MACs to promote three specific acknowledgement testing weeks with providers, and provide data and statistics to CMS to demonstrate readiness for the ICD-10 transition.
Effective date: 30 days from issuance for provider education, Business Requirement (BR) 2; November 17, 2014, for the November 2014 testing week; March 2, 2015, for the March 2015 testing week; June 1, 2015, for the June 2015 testing week
Implementation date: 30 days from issuance for provider education, Business Requirement (BR) 2; November 17 through 21, 2014, for the November testing week; March 2 through 6, 2015, for the March testing week; June 1 through 5, 2015, for the June testing week; November 26, 2014 for BR 6, for the November 2014 testing week; March 11, 2015, for BR 6, for the March 2015 testing week; June 10, 2015, for BR 6, for the June 2015 testing week
View Transmittal R1423OTN.
View MLN Matters article MM8858.
Learning tool on building respect for Lesbian, Gay, Bisexual, Transgender (LGBT) older adults
On August 22, CMS announced the release of a free learning tool on building respect for LGBT older adults. The learning tool addresses the needs and rights of older LGBT adults in long term care (LTC) and is presented in six online training modules. The learning tool is intended for LTC providers.
View the survey and certification letter.
Adjustment to implement National Uniform Billing Committee (NUBC) revision to Occurrence Span Code (OSC) definition for Code 72.
On August 25, CMS released a change request to implement the adjustment of a consistency edit to validate claims based on the revised NUBC definition for OSC "72".
Effective date: October 1, 2014
Implementation date: October 6, 2014
View Transmittal R3051CP.
OIG Advisory Opinion No. 14-07
On August 25, OIG posted an advisory opinion on use of a "preferred hospital" network as part of Medicare Supplemental Health Insurance ("Medigap") policies.
View the document.
CMS offering agreement to hospitals willing to withdraw pending appeals in exchange for partial payment
On August 29, CMS announced it will make an agreement with any hospital willing to withdraw their pending claims in exchange for timely partial payment. This agreement is available to acute care and critical access hospitals. Facilities in other categories are not eligible to submit a settlement request.
View the document.
Fingerprint-based background check begins August 6
On August 19, CMS released a Special Edition MLN Matters article stating fingerprint-based background checks will be required for all individuals with a 5% or greater ownership interest in a provider or supplier that falls into the high risk category and is currently enrolled in Medicare or has submitted an initial enrollment application.
View MLN Matters article SE1427