This week in Medicare updates
January 2015 update of the ASC payment system
On January 9, CMS released a recurring update notification describing changes to billing instructions for various payment policies implemented in the January 2015 ASC payment system update. It applies to Medicare Claims Processing Manual, Chapter 14, section 10. As appropriate, this notification also includes updates to the HCPCS. Transmittal 3158, dated December 24, 2014, is being rescinded and replaced by Transmittal 3163 to correct Attachment A, table 3. Table 3 erroneously included code A9606. The correct payment indicator for this code is S1 and should not have been included in table 3. A field name in table 3 will also be corrected to read "CY2015 PI" rather than "CY2015 SI". All other information remains the same.
Effective date: January 1, 2015
Implementation date: January 5, 2015
View Transmittal R3163CP.
View MLN Matters MM9021.
Remittance Advice Remark and Claims Adjustment Reason Code and Medicare Remit Easy Print and PC Print update
On January 9, CMS released a change request updating the Claim Adjustment Reason Code (CARC) and Remittance Advice Remark Code (RARC) lists and also instructs VIPs and FISS to update Medicare Remit Easy Print (MREP) and PC Print. This recurring update notification applies to Medicare Claims Processing Manual, Chapter 22, sections 40.5, 60.1, and 60.2.
Effective date: April 1, 2015
Implementation date: April 6, 2015
View Transmittal R3161CP.
View MLN Matters MM9004.
Moratorium on classification of long-term care hospitals (LTCH) or satellites/Increase in certified LTCH beds
In January 9, CMS released a change request providing details on how to apply the exceptions to the moratorium on the establishment of new LTCH and LTCH satellites under Section 1206 of the Pathways to SGR Reform Act (Pub. L.113-67).
Effective date: April 1, 2014
Implementation date: February 10, 2015
View Transmittal R1450OTN.
OASIS transition to the Automated Submission and Processing System (ASAP) and OASIS Correction policy
On January 9, CMS posted a notice confirming it implemented the newest version of OASIS, OASIS-C1/ICD-9 and convert OASIS transmission to the ASAP system. This memorandum outlines the changes to the OASIS transmission system and transition to the ASAP system, effective January 1, 2015. CMS will publish a new OASIS Correction policy for OASIS.
View the survey and certification letter.
CMS did not always correctly make clinic visit payments to hospitals during CY 2012
On January 13, the OIG posted a report asserting that CMS made incorrect outpatient payments to hospitals for established patients' clinic visits. On the basis of the OIG’s sample results, it estimated CMS made incorrect payments to hospitals totaling $4.6 million for 2012.
View the report.
Decision memorandum for Microvolt T-wave Alternans (CAG-00293R2)
On January 13, CMS posted a decision memorandum deciding that no NCD is appropriate at this time for microvolt T-wave alternans (MTWA) testing using the modified moving average (MMA) method for the evaluation of patients at risk for sudden cardiac death. National non-coverage will be removed. Medicare coverage of MTWA using the MMA method will be determined by the local contractors.
View the decision memorandum.
Medicare hospices have financial incentives to provide care in assisted living facilities (ALFs)
On January 14, the OIG posted a report finding that Medicare payments for hospice care in ALFs more than doubled in five years, totaling $2.1 billion in 2012. Hospices provided care much longer and received much higher Medicare payments for beneficiaries in ALFs than for beneficiaries in other settings.
View the report.
Notice of new interest rate for Medicare overpayments and underpayments-2nd Quarter notification for FY 2015
On January 14, CMS released a recurring update notification to Medicare Regulation 42 CFR Section 405.378, which provides for the charging and payment of interest on overpayments and underpayments to Medicare providers. The Secretary of Treasury certifies an interest rate quarterly. Treasury utilizes the most comprehensive data available on consumer interest rates to determine the certified rate. Interest is assessed on delinquent debts in order to protect the Medicare Trust Funds. This recurring update notification applies to Medicare Financial Management, Chapter 3, section 10.
Effective date: January 21, 2015
Implementation date: January 21, 2015
View Transmittal R249FM.
FFS NEMB SNF
On January 16, CMS updated the Notice of Exclusion from Medicare Benefits - Skilled Nursing Facility (NEMB SNF). This notice may be used with extended care item(s) and service(s) that are not Medicare benefits. NEMB-SNFs alert Medicare beneficiaries in advance that Medicare does not cover certain extended care item(s) and/or service(s) because the item or service does not meet the definition of a Medicare benefit or because the item or service has been specifically excluded by law.
View the website.