This week in Medicare updates
Revisions to State Operations Manual (SOM), Appendix A–Survey protocol, regulations and interpretive guidelines for hospitals
On September 26, CMS released a transmittal revising Appendix A, Survey Protocol, Regulations and Interpretive Guidelines for Hospitals to reflect recent regulation changes concerning the Governing Body and Medical Staff Conditions of Participation. The transmittal also makes clarifications and updates to existing guidance.
Effective date: September 26, 2014
Implementation date: September 26, 2014
View Transmittal R122SOMA.
October 2014 update of the ASC payment system
On September 26, CMS released a change request to describe changes to and billing instructions for various payment policies implemented in the October 2014 ASC payment system update. This Recurring Update Notification applies to Chapter 14, Medicare Claims Processing Manual, section 10. As appropriate, this notification also includes updates to the HCPCS.
Effective date: October 1, 2014
Implementation date: October 6, 2014
View Transmittal R3078CP.
Update to Pub. 100-04, Medicare Claims Processing Manual, Chapter 23 to provide language-only changes for conversion to ICD-10
On September 26, CMS released a change request containing language-only changes for updating ICD-10 language in Pub 100-04, Chapter 23. There are no new coverage policies, payment policies, or codes introduced in this transmittal. Specific policy changes and related business requirements have been announced previously in various communications. Transmittal 3020, dated August 8, is being rescinded and replaced by Transmittal 3081, dated September 26, to delete the general rules for reporting diagnoses on claims in section 10.1. Providers have questioned if these bullets were providing different information than the Official ICD-9-CM and Official ICD-10-CM coding guidelines. This interpretation was not intended. Providers must refer to the Official ICD-9-CM and Official ICD-10-CM guidelines, which are a HIPAA standard, for these instructions. The location of the guidelines is shown in this section. All other information remains the same.
Effective date: Upon implementation of ICD-10
Implementation date: Upon implementation of ICD-10
View Transmittal R3081CP.
October 2014 update of OPPS
On September 26, CMS released a change request describing changes to and billing instructions for various payment policies implemented in the October 2014 OPPS update. The October 2014 Integrated Outpatient Code Editor (I/OCE) and OPPS Pricer will reflect HCPCS, APC, HCPCS Modifier, and Revenue Code additions, changes, and deletions identified in this change request. This Recurring Update Notification applies to Chapter 4, Medicare Claims Processing Manual, section 50.8. Transmittal 3012, dated August 1, is being rescinded and replaced by Transmittal 3080, dated September 26, to correct the long descriptor for HCPCS code C9135 in table 2 in the attachment A-Tables for the Policy Section.
Effective date: October 1, 2014
Implementation date: October 6, 2014
View Transmittal R3080CP.
View MLN Matters article MM8873.
Recovery Audit Program Tracking Appeals and Reopenings
On September 26, CMS released a change request pertaining to the national Recovery Audit Program. It amends 100.9.2, Tracking Appeals and Reopenings, so it is consistent with the current standard systems tracking capabilities. Transmittal 226, dated September 6, 2013, is being rescinded and replaced by Transmittal 241, dated September 26, 2014 to reflect up-to-date MAC processes. All other information remains the same.
Effective date: October 7, 2013
Implementation date: October 7, 2013
View Transmittal R241FM.
Categorical waiver for power strips use in patient care areas
On September 26, CMS posted a determination that the 2000 edition of the National Fire Protection Association (NFPA) 101® Life Safety Code (LSC) contains provisions on the use of power strips in healthcare facilities that may result in unreasonable hardship for providers or suppliers. Further, an adequate alternative level of protection may be achieved by compliance with the 2012 edition of the LSC, which has extended allowances on the use of power strips in patient care areas.
View the survey and certification letter.
CMS makes first wave of drug & device company payments to teaching hospitals and physicians public
As part of its ongoing effort to increase transparency and accountability in healthcare, on September 30 CMS released the first round of Open Payments data to help consumers understand the financial relationships between the healthcare industry, and physicians and teaching hospitals.
View the press release.
Update to inpatient psychiatric facilities prospective payment system (IPF PPS) FY 2015
On September 30, CMS released a change request that identifies changes that are required as part of the annual IPF PPS update from the FY 2015 IPF PPS final rule, published on August 1, 2014. 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 R3082CP.
View MLN Matters article MM8889.
Correction to inpatient rehabilitation facility PPS for Federal FY 2015
On October 1, CMS posted a document in the Federal Register correcting technical errors that appeared in the final rule with comment period published in the Federal Register on August 6, 2014 entitled ‘‘Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2015’’ (79 FR 45872). These changes are effective October 1.
View the notice in the Federal Register.
Updated hospital appeals settlement offer Frequently Asked Questions
On October 1, CMS updated its website to allow review of an updated Frequently Asked Question document.
Access the Frequently Asked Questions.
Fraud and Abuse; Revisions to Safe Harbors under the Anti-Kickback Statute, and Civil Monetary Penalty rules regarding beneficiary inducements and gainsharing
On October 2, OIG posted a proposed rule on its website that would amend the safe harbors to the anti-kickback statute and the civil monetary penalty (CMP) rules under the authority of the Office of Inspector General (OIG). The proposed rule would add new safe harbors, some of which codify statutory changes set forth in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) and the Patient Protection and Affordable Care Act, Public Law 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Public Law 111-152, 124 Stat. 1029 (2010) (ACA), and all of which would protect certain payment practices and business arrangements from criminal prosecution or civil sanctions under the anti-kickback statute. It also proposes to codify revisions to the definition of “remuneration,” added by the Balanced Budget Act (BBA) of 1997 and ACA, and add a gainsharing CMP provision in our regulations.
View the website
https://www.federalregister.gov/articles/2014/10/03/2014-23182/medicare-and-state-health-care-programs-fraud-and-abuse-revisions-to-safe-harbors-under-the
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Revisions to State Operations Manual (SOM) Chapters 1, 2 and 3
On October 3, CMS released a change request to reflect current policies concerning hospitals enrolled in the Medicaid, but not also the Medicare program; reflect policies and procedures concerning providers and suppliers deemed to satisfy participation requirements on the basis of their accreditation by a CMS-approved Medicare accreditation program; reflect current regulations governing determination of the effective date of the Medicare agreement/supplier approval; and clarify the type of subsequent survey required when an initial applicant for participation in Medicare has been denied initial certification based on an initial survey findings.
Effective date: October 3, 2014
Implementation date: October 3, 2014
View Transmittal R123SOMA.
Correction to IPPS for Acute Care Hospitals and the LTCH PPS and FY 2015 rates; Quality reporting requirements for specific providers; Reasonable compensation equivalents for physician services in excluded hospitals and certain teaching hospitals; Provider administrative appeals and judicial review; Enforcement provisions for organ transplant centers; and EHR Incentive Program
On October 3, CMS posted a document on the Federal Register correcting technical and typographical errors in the final rule that appeared in the August 22 Federal Registerwith the same title. Changes are effective October 1.
View the notice in the Federal Register.
Proposed Collection; Comment Request
On October 3, CMS posted a notice in the Federal Register relating that it is accepting comments on: CMS–10538, Prior Authorization Form for Beneficiaries Enrolled in Hospice. Comments are due December 2.
View the notice in the Federal Register.
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