This week in Medicare updates
Physician Quality Reporting System 2013 reporting year and 2015 payment adjustment for rural health clinics, federally qualified health centers, and critical access hospitals
On March 6, CMS released a special edition MLN Matters article intended to provide answers to some frequently asked questions raised by staff at rural health clinics, federally qualified health centers, and critical access hospitals.
View special edition MLN Matters article SE1508.
ICD-10 conversion/coding infrastructure revisions/ICD-9 updates to NCDs
On March 6, CMS released the second maintenance update change request of ICD-10 conversions and ICD-9 coding updates specific to national coverage determinations (NCDs). The majority of the NCDs included are a result of feedback received from previous ICD-10 NCD CR7818, CR8109, CR8197, and CR8691. Some are the result of revisions required to other NCD-related change requests released separately that also included ICD-10 coding.
Effective date: April 6, 2015, for designated ICD-9 updates and all local system edits (ICD-9 and ICD-10); July 1, 2015, for all ICD-9 shared system edits; October 1, 2015, for all ICD-10 shared system edits (or whenever ICD-10 is implemented)
Implementation date: April 6, 2015, for designated ICD-9 updates and all local system edits; July 6, 2015, for ICD-9 and ICD-10 shared system edits
View Transmittal R1478OTN.
View MLN Matters article MM9087.
Payments to hospice agencies that do not submit required quality data
On March 6, CMS released a transmittal regarding the payment reduction facing hospice agencies not submitting required quality data. For fiscal year 2014, and each subsequent year, if a hospice agency does not submit this data, their payment rates for the year are reduced by 2 percentage points for that fiscal year. Application of the 2% reduction may result in an update less than 0.0 for a fiscal year and in payment rates for a fiscal year being less than such payment rates for the preceding fiscal year. In addition, reporting-based reductions to the market basket increase factor will not be cumulative; they will only apply for the FY involved.
Effective date: June 8, 2015, for non systems changes
Implementation date: June 8, 2015, for non systems changes
View Transmittal R39QRI.
View MLN Matters article MM9091.
Removal of multiple NCDs using expedited process
On March 6, CMS released a change request to remove sections 50.6 - Tinnitus masking, 160.4 - Stereotactic Cingulotomy as a Means of Psychosurgery, 160.6 - Carotid Sinus Nerve Stimulator, 160.9 - Electroencephalographic (EEG) Monitoring During Open-Heart Surgery, 190.4 - Electron Microscope, 220.7 - Xenon Scan, 220.8 - Nuclear Radiology Procedure, from Pub. 100-03, Medicare National Coverage Determinations Manual.
Effective date: December 18, 2014
Implementation date: April 6, 2015
View Transmittal R180NCD.
View MLN Matters article MM9095.
View the NCD website pages regarding these retired and removed items:
NCD for Tinnitus Masking.
NCD for Nuclear Radiology Procedure.
NCD for Xenon Scan.
NCD for Electron Microscope.
NCD for Electronecephalographic (EEG) Monitoring During Open-Heart Surgery.
NCD for Carotid Sinus Nerve Stimulator.
NCD for Stereotactic Cingulotomy as a Means of Psychosurgery.
New York Hospital Queens incorrectly billed Medicare inpatient claims with Kwashiorkor
On March 6, OIG posted a report stating New York Hospital Queens, in Flushing New York, did not comply with Medicare requirements for billing Kwashiorkor on any of the 64 claims reviewed.
View the report.
Medicare Compliance Review of Mercy Hospital in Saint Louis for 2011 and 2012
On March 6, OIG posted a report stating Mercy Hospital in Saint Louis complied with Medicare billing requirements for 151 of the 205 inpatient and outpatient claims reviewed. However, it did not fully comply with Medicare billing requirements for the remaining 54 claims, resulting in overpayments of $329,000 for calendar years (CYs) 2011 and 2012 (48 claims) and CYs 2010 and 2013 (6 claims).
View the report.
Screening for hepatitis C virus (HCV) in adults
On March 11, CMS released a change request regarding screening adults for HCV. Transmittal 3127, dated November 19, 2014, is being rescinded and replaced by Transmittal 3215 to: (1) replace "January 1, 2015 MPFSDB" with "January 1, 2016 CLFS" in BR8871-04.1, (2) remove TOS 50 (FQHC) and 72 (RHC) from BR8871-04.9, (3) clarify payment method for 13X, add clarifying language for FQHC and RHC, and remove incorrect language regarding claims processing for FQHC and RHC in BR8871-04.10, (4) clarify MAC claims processing prior to January 1, 2016, in 8871-04.12, and, (5) make corresponding changes to the Claims Processing Manual. All other information remains the same.
Effective date: June 2, 2014
Implementation date: January 5, 2015, for non-shared MAC edits and CWF analysis; April 6, 2015, for remaining shared systems edits
View Transmittal R3215CP.
April 2015 update of the ASC payment system
On March 11, CMS released a change request describing changes to billing instructions for various payment policies implemented in the April 2015 ASC payment system update. This recurring update notification applies to Medicare Claims Processing Manual, Chapter 14, section 10. As appropriate, this notification also includes updates to the HCPCS. Transmittal 3212, dated March 6, is being rescinded and replaced by Transmittal 3214 to correct the short descriptor for Q9975. All other information remains the same.
Effective date: April 1, 2015
Implementation date: April 6, 2015
View Transmittal R3214CP.
View MLN Matters article MM9100.
Quality Incentive Program; Correction
On March 13, CMS posted a notice in the Federal Register correcting technical errors in the final rule published in the Federal Registeron November 6, 2014 entitled ‘‘End-Stage Renal Disease Prospective Payment System, Quality Incentive Program, and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies.’’ This correction is effective today, March 13.
View the notice in the Federal Register.