This week in Medicare updates
FAQs–ICD-10 acknowledgement testing and end-to-end testing
On January 5, CMS released a Special Edition MLN Matters article regarding frequently asked questions for physicians, providers, suppliers, clearinghouses, and billing agencies who participate in acknowledgement testing and who are selected to participate in Medicare ICD-10 end-to-end testing. These parties should review the following questions and answers before preparing claims for ICD-10 acknowledgement testing and end-to-end testing to gain an understanding of the guidelines and requirements for successful testing.
View Special Edition MLN Matters article SE1501.
Submit adequate documentation to ensure claims are supported as billed
On January 5, CMS and the CERT Part A and Part B (A/B) MAC Outreach & Education Task Force released a fact sheet discussing the importance of submitting adequate documentation to ensure that claims are supported as billed.
View the fact sheet.
OIG Advisory Opinion No. 14-11
On January 5, the OIG posted OIG Advisory Opinion No. 14-11 on its website.
See OIG Advisory Opinion No. 14-11.
Update-intensive behavioral therapy for obesity, screening digital tomosynthesis mammography, and anesthesia associated with screening colonoscopy
On January 7, CMS released a change request to ensure accurate program payment for three screening services for which the beneficiary should not be charged the coinsurance or deductible. The coinsurance and deductible for these services are currently waived, but due to coding changes and additions to the Medicare Physician Fee Schedule Database, the payments for CY 2015 would not be accurate without this change request for intensive behavioral group therapy for obesity, digital breast tomosynthesis, and anesthesia associated with colorectal cancer screening tests. Transmittal 3146, dated December 11, 2014, is being rescinded and replaced by Transmittal 3160 to delete MCS and CWF responsibility from BR 8874.15 and to delete MCS responsibility from BR 8874.15.1. All other information remains the same.
Effective date: January 1, 2015
Implementation date: January 5, 2015
View Transmittal R3160CP.
New timeframe for response to Additional Documentation Requests (ADRs)
On January 7, CMS released a change request to update section 3.2.3.2 of Chapter 3 of the Program Integrity Manual to address the new prepayment review timeframe for ADRs submission and to also instruct the Shared Systems Maintainers to produce ADRs to reflect the new change. Transmittal 554, issued November 14, 2014, is being rescinded and replaced by Transmittal 566, to insert revisions from change request 9012 not included in the original issuance. All other information remains the same.
Effective date: April 1, 2015
Implementation date: April 6, 2015
View Transmittal R566PI.
Updated MA ED Notices
On January 7, CMS posted new NOMNC and DENC form instructions available below, in 'Downloads'. Neither the NOMNC nor the DENC form has changed, and providers may continue using the current forms.
View the website.
Fluorodeoxyglucose (FDG) Positron Emission Tomography (PET) for solid tumors
On January 8, CMS released a change request for claims with dates of service on and after June 11, 2013, stating CMS shall cover three FDG PET scans when used to guide subsequent management of anti-tumor treatment strategy after completion of initial anti-cancer therapy for the same cancer diagnosis. Coverage of any additional FDG PET scans (that is, beyond three) used to guide subsequent management of anti-tumor treatment strategy after completion of initial anti-cancer therapy for the same diagnosis will be determined by the local Medicare Administrative Contractors. Transmittal 2932, dated April 18, 2014 is being rescinded and replaced by Transmittal 3162 to remove Attachment A to the Pub. 100-04, Medicare Claims Processing Manual, and replaced with a web link in section 60.16A of the manual instruction that includes the list of appropriate diagnosis codes. Additionally, a diagnosis code 793.11 that was inadvertently left off has been included. All other information remains the same. This change request rescinds and fully replaces change request 8468/TR2873 dated February 6, 2014.
View Transmittal R3162CP.