This week in Medicare updates
Update to CMS publication 100-08, Program Integrity Manual, Chapter 3, section 3.2.3.4 (Additional Documentation Request Required and Optional Elements)
On November 26, CMS released a change request to update Chapter 3, Section 3.2.3.4 of the Program Integrity Manual (PIM). The changes address Additional Documentation Request (ADR) reporting requirements for MAC, Recovery Auditors, Comprehensive Error Rate Testing (CERT), and Supplemental Medical Review Contractor (SMRC). The templates are provided to show the elements, formatting, and order contractors shall use when constructing postpayment ADR letters. Contractors shall maintain the format of the letter, but have the discretion to insert case-specific information.
Effective date: December 29, 2014
Implementation date: December 29, 2014
View Transmittal R557PI.
Revisions to Pub. 100-08, Program Integrity Manual, Chapter 15
On November 26, CMS released a change request to update add certain provider enrollment policy clarifications to Chapter 15 of the PIM.
Effective date: December 29, 2014
Implementation date: December 29, 2014
View Transmittal R556PI.
View MLN Matters article MM8810.
FY 2015 IPPS and long term care hospital (LTCH) PPS changes
On November 26, CMS released a change request providing the FY 2015 update to the IPPS and LTCH PPS. This Recurring Update Notification applies to Chapter 3, section 20.2.3.1. Transmittal 3066, dated September 12, 2014, is being rescinded and replaced by Transmittal 3138 to correct information related to technical errors cited in the correction notice, CMS-1607-CN, published October 3, 2014.
Effective date: October 1, 2014
Implementation date: October 6, 2014
View Transmittal R3138CP.
Quarterly update for the DME Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program (CBP)-April 2015
On November 26, CMS released a change request to update the DME CBP files, which is done on a quarterly basis in order to implement necessary changes to the HCPCS, ZIP code, Single payment amount, and Supplier files. These requirements provide specific instruction for implementing the DMEPOS CBP files. The Recurring Update Notification applies to Medicare Claims Processing Manual, Chapter 23, section 100.
Effective date: April 1, 2015
Implementation date: April 6, 2015
View Transmittal R3136CP.
View MLN Matters article MM8918.
Quarterly update to the CCI Edits, Version 21.1
On November 26, CMS released the normal update to the CCI procedure to procedure edits. The attached Recurring Update Notification applies to Medicare Claims Processing Manual, Chapter 23, section 20.9.
Effective date: April 1, 2015
Implementation date: April 6, 2015
View Transmittal R3132CP.
View MLN Matters article MM8908.
Revisions to State Operations Manual (SOM), Appendix PP–“Guidance to Surveyors for Long Term Care Facilities”
On November 26, CMS released an instruction revising the Interpretive Guidelines and, in some instances, associated Investigative Protocols for several F Tags to reflect incorporation of Survey & Certification policy memo guidance issued from Fiscal Year 2003 through May 2014.
Effective date: November 26, 2014
Implementation date: November 26, 2014
View Transmittal R127SOMA.
Public release of three hospital surveyor worksheets
On November 26, CMS finalized surveyor worksheets for assessing compliance with three Medicare hospital CoPs: Quality Assessment and Performance Improvement (QAPI), Infection Control, and Discharge Planning. The worksheets are used by State and Federal surveyors on all survey activity in hospitals when assessing compliance with any of these three CoPs. Via this memorandum we are making the worksheets publicly available. The hospital industry is encouraged, but not required, to use the worksheets as part of their self-assessment tools to promote quality and patient safety.
View the survey and certification letter.
View the Hospital Infection Control Worksheet.
View the Hospital Quality Assessment Performance Improvement (QAPI) Worksheet.
View the Hospital Discharge Planning Worksheet.
Conditions of Participation for home health agencies; extension of comment period
On December 1, CMS posted a notice extending the comment period for the October 9, 2014 proposed rule entitled ‘‘Conditions of Participation for Home Health Agencies’’ (79 FR 61164). The comment period for the proposed rule, which would have ended on December 8 is extended for 30 days. The comment period is extended until 5 p.m. Eastern on January 7, 2015.
View the notice in the Federal Register.
Leave a comment.
CMS releases new proposal to improve Accountable Care Organizations
On December 1, CMS released a proposal to strengthen the Shared Savings Program for Accountable Care Organizations (ACOs) through a greater emphasis on primary care services and promoting transitions to performance-based risk arrangements. The proposed rule reflects input from program participants, experts, consumer groups, and the stakeholder community at large. CMS is seeking to continue this important dialogue to ensure that the Medicare Shared Savings Program ACOs are successful in providing seniors and people with disabilities with better care at lower costs.
View the press release.
Implementation of changes in the end-stage renal disease prospective payment system (ESRD PPS) for calendar year (CY) 2015
On December 2, CMS released a change request implementing the CY 2015 rate updates for the ESRD PPS. This recurring update notification applies to Pub. 100-02, Medicare Benefit Policy Manual, Chapter 11, section 50. In addition, updates included in Pub. 100-04, Medicare Claims Processing, Chapter 8, section 50.3.
Effective date: January 1, 2015
Implementation date: January 5, 2015
View Transmittal R3139CP.
Home health prospective payment system (HH PPS) rate update for CY 2015
On December 2, CMS released a change request updating the 60-day national episode rates, the national per-visit amounts, LUPA add-on amounts, and the non-routine medical supply payment amounts under the HH PPS for CY 2015. The attached Recurring Update Notification applies to Pub. 100-04, Medicare Claims Processing Manual, chapter 10, section 70.5. Transmittal 3101, dated October 31, 2014, is being rescinded and replaced by Transmittal 3140 to correct typographical errors in the wage index. Also, the CR is no longer sensitive/controversial. All other information remains the same.
Effective date: January 1, 2015
Implementation date: January 5, 2015
View Transmittal R3140CP.
CY 2015 home health prospective payment system rate update; quality reporting requirements and survey and enforcement requirements for HHA; Correction
On December 2, CMS posted a document in the Federal Register correcting a technical error in the final rule that appeared in the Federal Registeron November 6, entitled ‘‘Medicare and Medicaid Programs; CY 2015 Home Health Prospective Payment System Rate Update; Home Health Quality Reporting Requirements; and Survey and Enforcement Requirements for Home Health Agencies.’’
View the notice in the Federal Register.
Proposed changes to the Medicare Shared Savings Program regulations
On December 2, CMS issued a proposed rule to update and improve policies governing the Medicare Shared Savings Program (Shared Savings Program). The proposed rule addresses proposed changes to several program areas including beneficiary assignment, data sharing, available risk models, eligibility requirements, participation agreement renewals, and compliance and monitoring. Additionally, the proposed rule seeks comment on issues related to financial benchmarking and waivers for program and other payment rules. Changes to the Shared Savings Program quality reporting requirements were finalized in the CY2015 Medicare Physician Fee Schedule on October 31.
View the fact sheet.
Provider enrollment requirements for writing prescriptions for Medicare Part D drugs
On December 3, CMS released a Special Edition MLN Matters article regarding its announcement that it will delay enforcement of the requirements in 42 CFR 423.120(c)(6) until December 1, 2015. Nevertheless, prescribers of Part D drugs must submit their Medicare enrollment applications or opt-out affidavits to their Part B MACs by June 1, 2015, or earlier, to ensure that MACs have sufficient time to process the applications or opt out affidavits and avoid their patients’ prescription drug claims from being denied by their Part D plans, beginning December 1, 2015.
View MLN Matters Special Edition article SE1434.
CMS finalizes new safeguards to reduce Medicare fraud
On December 3, CMS issued a final rule that will improve its’ ability to deny or revoke the enrollment of entities and individuals that pose a program integrity risk to Medicare. The fact sheet summarizes CMS’ regulatory additions and changes, including expanded ability to deny enrollment based on certain criteria.
View the fact sheet.
View the press release.
Requirements for the Medicare Incentive Reward Program and Provider Enrollment
On December 5, CMS posted a final rule in the Federal Register implementing various provider enrollment requirements. These include: Expanding the instances in which a felony conviction can serve as a basis for denial or revocation of a provider or supplier’s enrollment; if certain criteria are met, enabling us to deny enrollment if the enrolling provider, supplier, or owner thereof had an ownership relationship with a previously enrolled provider or supplier that had a Medicare debt; enabling us to revoke Medicare billing privileges if we determine that the provider or supplier has a pattern or practice of submitting claims that fail to meet Medicare requirements; and limiting the ability of ambulance suppliers to ‘‘backbill’’ for services performed prior to enrollment. These regulations will be effective February 3, 2015.
View the notice in the Federal Register.
Provider enrollment application fee amount for CY 2015
On December 5, CMS posted a notice in the Federal Register announcing a $553.00 CY 2015 application fee for institutional providers that are initially enrolling in the Medicare or Medicaid program or the Children’s Health Insurance Program (CHIP); revalidating their Medicare, Medicaid, or CHIP enrollment; or adding a new Medicare practice location. This fee is required with any enrollment application submitted on or after January 1, 2015 and on or before December 31, 2015. This notice is effective January 1, 2015.
View the notice in the Federal Register.