This week in Medicare updates
Correction to remittance messages when hospice claims are reduced due to late filing of the Notice of Election
On November 6, CMS released a change request revising the remittance advice messages applied to hospice claims when days are non-covered due to late filing of a Notice of Election. The messages will indicate that these days are appealable.
Effective date: October 1, 2014
Implementation date: April 6, 2015
View Transmittal R3118CP.
View MLN Matters article MM8923.
Medicare coverage of Category A and B Investigational Device Exemption studies
On November 6, CMS released a change request to update the manual instructions for Medicare coverage requirements and to review procedures related to items and services in FDA-approved Category A and B Investigational Device Exemptions in order to reflect current policy.
Effective date: January 1, 2015
Implementation date: January 5, 2015
View Transmittal R198BP.
View Transmittal R3105CP.
View MLN Matters article MM8921.
Additional instruction on the use of Claims Adjustment Reason Codes (CARCs) and Remittance Advice Remark Codes (RARCs) with regard to Operating Rule: 360 Compliance
On November 6, CMS released a change request to provide further instruction on the use of CARCs independently and the use of CARC and RARCs in combinations not defined by the Council for Affordable Quality Healthcare Committee on Operating Rules for Information Exchange Code Combination Four (4) defined Business Scenarios.
Effective date: April 1, 2015
Implementation date: April 6, 2015
View Transmittal R1433OTN.
Rural health clinics (RHCs) and federally qualified health centers (FQHCs) under the All-Inclusive Rate system
On November 6, CMS released a change request adding G0101 and Q0091 to the list of preventive services paid based on the all-inclusive rate for RHCs and FQHCs.
Effective date: January 1, 2014
Implementation date: April 6, 2015
View Transmittal R1434OTN.
View MLN Matters article MM8927.
New Informational Unsolicited Response (IUR) process for DME items furnished during a Part A hospital inpatient stay
On November 6, CMS released a change request creating a new line item IUR to include DME and discharge date for claims received during a Part A Hospital Inpatient Stay. Change request 8172 provided guidance on CMS’ longstanding edits in place to deny claims for DME items furnished during an inpatient stay. However, this change request only addressed Prosthetics and Orthotics and did not include DME. In addition it provided instructions for the date of service through discharge date, but did not include day of discharge, requiring clarification with this new change request.
Effective date: April 1, 2015
Implementation date: April 6, 2015
View Transmittal R1435OTN.
View MLN Matters article MM8844.
Implementing the payment policies related to patient status from the CMS-1599-F
On November 6, CMS released a change request implementing the payment policies related to Patient Status from the CMS-1599-F. It includes payment of Medicare Part B inpatient services; and admission and medical review criteria for payment of hospital inpatient services under Medicare Part A.
Effective date: October 1, 2013
Implementation date: February 10, 2015
View Transmittal R3106CP.
View MLN Matters article MM8959.
Elimination of the 50/50 payment rule for laboratory services on ESRD claims
On November 6, CMS released a change request updating billing requirements for ESRD facilities and claims processing requirements for Original Medicare systems to no longer apply the 50/50 payment rule for Automated Multi-Channel Chemistry laboratory tests.
Effective date: April 1, 2015
Implementation date: April 6, 2015
View Transmittal R3116CP.
View MLN Matters article MM8957.
Dialysis Facility Compare (DFC) Star Ratings and data release
On November 7, CMS posted a fact sheet regarding that it has finalized the methodology for its DFC Star Rating program and is releasing previews of ratings to individual Medicare-participating dialysis facilities. Facilities will have 15 days to review their ratings. CMS expects to post ratings to Dialysis Facility Compare in January 2015. CMS presented the DFC Star Rating methodology earlier this year, but in response to stakeholder concerns, delayed rollout of the Star Ratings on DFC from October 2014 until January 2015. This allowed CMS to receive comments, consider modification of the methodology, and respond to the dialysis community’s comments.
View the fact sheet.
Information for clinical laboratories concerning possible Ebola Virus Disease
On November 7, CMS posted information from the CDC with interim guidance for specimen collection, transport, testing and submission for persons under investigation for Ebola virus disease in the United States. Before collecting any specimens, one should coordinate with the State Public Health Laboratory/CDC. It contains information regarding personal protective equipment to be used by healthcare workers. Laboratory employees and other workers handling specimens for Ebola testing are strongly urged to review and fully adopt and implement this guidance. FDA Test System Information for hospitals and laboratories is provided, which includes test manufacturer, methodology, quality control and test validation. Surveyors are to assess compliance for only CLIA. All regulations remain in effect.
View the survey and certification letter.
Request for nominations for members for the Medicare Evidence Development & Coverage Advisory (MEDCAC) committee
On November 10, CMS posted a notice in the Federal Register announcing the request for nominations for membership on the MEDCAC. Among other duties, the MEDCAC provides advice and guidance to the Secretary of the Department of HHS and the Administrator of CMS concerning the adequacy of scientific evidence available to CMS in making coverage determinations under the Medicare program. The MEDCAC reviews and evaluates medical literature and technology assessments, and hears public testimony on the evidence available to address the impact of medical items and services on health outcomes of Medicare beneficiaries. Nominations are due December 8.
View the notice in the Federal Register.
Proposed Decision Memorandum for screening for lung cancer with Low Dose Computed Tomography (LDCT)
On November 10, CMS posted a proposed decision memorandum stating the evidence is sufficient to add a lung cancer screening counseling and shared decision making visit, and for appropriate beneficiaries, screening for lung cancer with low dose computed tomography (LDCT), once per year as an additional preventive service benefit. Certain criteria, including age, symptomatology and other factors, must be met.
View the proposed decision memorandum.
Revised CMS 855R Application-Reassignment of Medicare Benefits
On November 14, a Special Edition MLN Matters article was released. This article states all providers and suppliers must use the revised CMS 855R (Reassignment of Benefits) application beginning June 1, 2015.
View Special Edition MLN Matters article SE1432.
Prior Authorization of repetitive scheduled nonemergent ambulance transports
On November 14, CMS posted a notice in the Federal Register announcing a three-year Medicare Prior Authorization model for repetitive scheduled nonemergent ambulance transport in certain states where there have been high incidences of improper payments for these services. This model will begin on December 1 in South Carolina, New Jersey, and Pennsylvania.
View the notice in the Federal Register.
Quarterly listing of program issuances-July through September 2014
On November 14, CMS posted a quarterly notice in the Federal Register listing CMS manual instructions, substantive and interpretive regulations, and other Federal Registernotices published from July through September 2014, relating to the Medicare and Medicaid programs and other programs administered by CMS.
View the notice in the Federal Register.