This week in Medicare updates
Use of Modifiers KK, KG, KU, and KW under the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program
On February 13, CMS released a change request that will limit the use of modifiers KK, KG, KU and KW on DMEPOS claims billed under the Competitive Bidding Program to only those uses allowed by current policy. This will reduce the number of overpayments made as a result of improper use by suppliers.
Effective date: July 1, 2015
Implementation date: July 6, 2015
View Transmittal R1466OTN.
View MLN Matters article MM9059.
Reporting force balance claim payment on the Electronic Remittance Advice (ERA) 835 and Cross Over Beneficiary (COB) 837 claim transactions
On February 13, CMS released a change request providing instruction to modify the way that Out of Balance (OOB) claim payment is reported by the Shared System Maintainers (SSMs) on the 837 COB and 835 transactions.
Effective date: July 1, 2015
Implementation date: July 6, 2015
View Transmittal R1467OTN.
View MLN Matters article MM9050.
Recurring update to the federally qualified health centers (FQHC) PPS
On February 13, CMS released a change request updating the Geographic Practice Cost Index (GPCIs) for the FQHC Pricer.
Effective date: April 1, 2015
Implementation date: April 6, 2015
View Transmittal R3194CP.
Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS) Competitive Bidding Program (CBP): Additional instructions for grandfathered items subject to CBP
On February 13, CMS released a change request to instruct the claims processing DME MAC contractors and the VMS Shared System maintainer to adjust their systems as necessary so as to process and pay claims for grandfathered DME items subject to CBP, rental items, and oxygen supply items according to the various payment policies included in the change request.
Effective date: July 1, 2015
Implementation date: July 6, 2015
View Transmittal R1470OTN.
View MLN Matters article MM9060.
Payment repairs to capped rental equipment prior to the end of the 13-month cap
On February 13, CMS released a change request instructing the contractors to ensure editing occurs to all payment for reasonable and necessary maintenance and servicing of capped rental items. This instruction applies in cases where one or more rental payments have been made for a capped rental item, and the supplier transfers the title to the equipment to the beneficiary prior to the end of a 13 month period of continuous use.
Effective date: July 1, 2015
Implementation date: July 6, 2015
View Transmittal R3196CP.
View Transmittal R203BP.
View MLN Matters article MM9062.
MDS/Staffing focused surveys update
On February 13, CMS posted a survey and certification letter regarding a focused survey to assess MDS coding practices and its relationship to resident care in nursing homes. CMS subsequently announced they would expand the MDS focused surveys to all states and include a review of nursing home staffing. This memo provides an update on the pilot and the status of the expansion of these surveys including training for the next surveys, which will begin in early April 2015. States will need to assign a minimum of three surveyors to be trained. Training and surveys will be rolled out in two phases with regions and states assigned to one of two groups. Deficiencies identified during the surveys will result in relevant citations and enforcement actions.
View the survey and certification letter.
EMTALA and Ebola Virus Disease (EVD)–Questions and Answers (Q+A)
On February 13, CMS posted a survey and certification letter concerning questions about the requirements in dealing with EVD. On November 21, 2014 CMS Survey & Certification Group released SC 15-10-Hospitals concerning EMTALA Requirements and Implications Related to the EVD. CMS has received follow-up questions regarding EMTALA and Ebola and has produced a Q+A document in response.
View the survey and certification letter.
Medicare Quarterly Provider Compliance Newsletter
MLN Matters released the January 2015 edition of the Medicare Quarterly Provider Compliance Newsletter.
View the newsletter.