This week in Medicare updates
Physician Feedback, Quality and Resource Use Reports (QRURs) and Value-Based Modifier Program–Overview & Implementation
On February 27, CMS released a special edition MLN Matters article providing an overview of the Physician Feedback and Value-Based Modifier Program. Under the Value Modifier Program, performance on quality and cost measures can translate into payment incentives for providers who provide high quality, efficient care, while providers who underperform may be subject to a downward adjustment.
View special edition MLN Matters article SE1507.
April CY 2015 quarterly update to the Medicare Physician Fee Schedule Database
On February 27, CMS released a change request amending payment files issued to contractors based upon the CY 2015 Medicare Physician Fee Schedule final rule. This recurring update notification applies to Pub. 100-04, Medicare Claims Processing Manual, Chapter 23, section 30.1.
Effective date: January 1, 2015 for dates of service on or after January 1 unless otherwise stated
Implementation date: April 6, 2015
View Transmittal R3205CP.
View MLN Matters article MM9104.
New waived tests
On February 27, CMS released a change request to inform contractors of new CLIA waived tests approved by the FDA. Since these tests are marketed immediately after approval, CMS must notify its contractors of the new tests so that the contractors can accurately process claims. There are 30 newly added waived complexity tests.
Effective date: April 1, 2015
Implementation date: April 6, 2015
View Transmittal R3207CP.
View MLN Matters article MM9072.
Contacting ESRD Networks for survey related facility information
On February 27, CMS posted a survey and certification letter about its policy regarding contacting providers/suppliers prior to entry for survey. Surveyors should contact the ESRD Networks for facility information after entering the ESRD facility building for survey purposes.
View the survey and certification letter.
Community Mental Health Center (CMHC) frequently asked questions (FAQs)
On February 27, CMS posted a survey and certification letter in response to the numerous questions received during the recent CMHC basic surveyor training courses. CMS compiled a list of FAQs and responses. The FAQs are provided to promote greater surveyor consistency nationally and will be incorporated into Interpretive Guidance as indicated.
View the survey and certification letter.
OIG Advisory Opinion No. 15-03
On March 2, OIG posted an advisory opinion regarding the proposed use of a “preferred hospital” network as part of Medicare Supplemental Health Insurance (“Medigap”) policies.
View the opinion.
Incorporation of certain provider enrollment policies into Pub. 100-08, Program Integrity Manual (PIM), Chapter 15
On March 4, CMS released a change request to incorporate provisions in CMS-6045-F into Pub. 100-08, PIM, Chapter 15. The change request also addresses several minor provider enrollment policy issues that have recently arisen.
Effective date: May 28, 2015
Implementation date: May 28, 2015
View Transmittal R582PI.
View MLN Matters article MM9065.