This week in Medicare updates
Two-midnight policy and potential short stay payment solutions
On February 13, the American Hospital Association posted a letter urging CMS to offer potential payment solutions for hospital stays of less than two-midnights in its proposed rule for the FY 2016 IPPS. AHA also asks CMS to extend the partial enforcement delay of the "two-midnight" policy until the later of Oct. 1, 2015, or the agency’s implementation date of a short stay payment policy.
View the letter.
Contractors should develop plans for handling appeals in preparation for ICD-10 implementation
On February 13, CMS released a change request tasking contractors to evaluate and mitigate the potential impact to the appeals business area due to the implementation of ICD-10.
Effective date: March 16, 2015
Implementation date: March 16, 2015
View Transmittal R1469OTN.
NCD for single chamber and dual chamber permanent cardiac pacemakers
On February 20, CMS released a change request to inform contractors it issued a NCD and concluded that implanted permanent cardiac pacemakers, single chamber or dual chamber, are reasonable and necessary for the treatment of non-reversible symptomatic bradycardia due to sinus node dysfunction and second and/or third degree atrioventricular block.
Effective date: August 13, 2013
Implementation date: July 6, 2015
View Transmittal R179NCD.
View Transmittal R3204CP.
Automation of the request for reopening claims process
On February 20, CMS released a change request implementing National Uniform Billing Committee (NUBC) approved bill type and condition codes for a request for reopening. Transmittal 3154, dated December 19, 2014, is being rescinded and replaced by Transmittal 3203 to change the effective date to October 1, 2015, and implementation date to October 5, 2015. All other information remains the same.
Effective date: October 1, 2014 for analysis and Design (CWF, FISS and FISS USERS); Reopening Claims received on or after October 1, 2015 (CWF, FISS and FISS USERS)
Implementation date: October 6, 2014 for analysis and Design (CWF, FISS and FISS USERS); January 5, 2015, April 6, 2015, and July 6, 2015 (CWF, FISS and FISS USERS) for coding; October 5, 2015 for full Implementation (CWF, FISS and FISS USERS)
View Transmittal R3203CP.
Reasonable cost of therapy and other services furnished by outside suppliers
On February 20, CMS released a transmittal with changes to Provider Reimbursement Manual, Part 1, Chapter 14.
Effective date: The inflation factors are applied at the beginning of a cost reporting period.
View Transmittal R467PR1.
Revisions to State Operations Manual (SOM) Exhibit 138 EMTALA Physician Review Worksheet revisions
On February 20, CMS released a change request Exhibit 138 EMTALA Physician Review Worksheet has been revised to more accurately reflect EMTALA regulations. There have been no recent changes in the EMTALA regulations.
Effective date: February 13, 2015
Implementation date: February 13, 2015
View Transmittal R134SOMA.
Hospital appeals settlement update
On February 20, CMS posted an update to the hospital appeals settlement. CMS is in the process of completing Round 1 of the settlement process. Round 2 validations have begun. Settlement participants are encouraged to see the revised "Critical Steps for Providers in the Appeals Settlement Process" found in the Downloads section below for additional Round 2 instructions.
View the update.
Potential adverse impact of lower relative humidity (RH) in operating rooms (ORs)
On February 20, CMS posted a survey and certification letter for ASCs & supplemental information for hospitals & critical access hospitals (CAHs) using the Categorical Waiver of Life Safety Code (LSC) Anesthetizing Location RH Requirements. The Association for the Advancement of Medical Instrumentation (AAMI) coordinated the release on January 5, 2015 of a Joint Communication of multiple healthcare-related organizations on how a RH of <30% in ORs may affect the performance of some sterile supplies and electro-medical equipment.
View the survey and certification letter.
ICD-10 testing-Acknowledgement testing with providers
On February 24, CMS released a change request to instruct MACs to promote three specific acknowledgement testing weeks with providers, and provide data and statistics to CMS to demonstrate readiness for the ICD-10 transition. Transmittal 1423, dated August 22, 2014, is being rescinded and replaced by Transmittal 1472 to update the attached reporting template, remove "provided by CMS" from BR 8858.2, and add BR 8858.6.1 and BR 8858.6.2. All other information remains the same.
Effective date: 30 days from issuance for provider education, Business Requirement (BR) 2; November 17, 2014, for the November 2014 testing week; March 2, 2015, for the March 2015 testing week; June 1, 2015, for the June 2015 testing week
Implementation date: 30 days from issuance for provider education, Business Requirement (BR) 2; November 17 through 21, 2014, for the November testing week; March 2 through 6, 2015, for the March testing week; June 1 through 5, 2015, for the June testing week; November 26, 2014 - for BR 6, for the November 2014 testing week; March 11, 2015, for BR 6, for the March 2015 testing week; June 10, 2015, for BR 6, for the June 2015 testing week
View Transmittal R1472OTN.
Corrections to hospital OPPS and ASC PPS and quality reporting programs; Physician-owned hospitals: Data Sources for expansion exception; Physician certification of inpatient hospital services; Medicare Advantage organizations and Part D sponsors: CMS-identified overpayments associated with submitted payment data
On February 24, CMS posted a notice to the Federal Register correcting technical errors that appeared in the final rule with comment period published in the Federal Registeron November 10, 2014, entitled ‘‘Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Physician-Owned Hospitals: Data Sources for Expansion Exception; Physician Certification of Inpatient Hospital Services; Medicare Advantage Organizations and Part D Sponsors: CMS-Identified Overpayments Associated with Submitted Payment Data.’’ This document is effective February 24, 2015.
View the notice in the Federal Register.
View the hospital outpatient website.
Health Reform Oversight Plan
On February 24, OIG posted the Health Reform Oversight Plan.
View the plan.
Transitioning to ICD-10
On February 25, CMS released a fact sheet regarding the transition to ICD-10. It states CMS is working closely with all industry stakeholders to provide support in transitioning to ICD-10 on Oct. 1, 2015.
View the fact sheet.
HOP Panel meeting agenda
On February 26, CMS posted documents intended for use at the March 2015 HOP Panel Winter Meeting. These documents are based on a run of data from CY 2014 claims through September 2014. These documents are not reflective of the data used for the CY 2015 OPPS final rule.
View the website.
Right of appeal for Medicare secondary payer determinations relating to liability insurance, no-fault insurance, and workers' compensation laws and plans
On February 27, CMS posted a final rule in the Federal Register implementing provisions of the Strengthening Medicare and Repaying Taxpayers Act of 2012 (SMART Act) which require CMS to provide a right of appeal and an appeal process for liability insurance (including self-insurance), no-fault insurance, and workers’ compensation laws or plans when Medicare pursues a Medicare Secondary Payer (MSP) recovery claim directly from the liability insurance (including self-insurance), no-fault insurance, or workers’ compensation law or plan. These regulations are effective on April 28, 2015. Applicable plans are parties to initial determinations issued on or after April 28, 2015, where CMS pursues recovery directly from an applicable plan.
View the notice in the Federal Register.
Public meetings in calendar year 2015 for all new public requests for revisions to the HCPCS coding and payment determinations
On February 27, CMS posted a notice in the Federal Register announcing the dates, time, and location of the HCPCS public meetings to be held in 2015 to discuss their preliminary coding and payment determinations for all new public requests for revisions to the HCPCS. These meetings provide a forum for interested parties to make oral presentations or to submit written comments in response to preliminary coding and payment determinations.
View the notice in the Federal Register.