This week in Medicare updates
HIPAA EDI front end updates for July 2015
On March 26, CMS released a change request to provide the July 2015 Common Edits and Enhancements Module (CEM) edits for the Part A and Part B MACs (A/B MACs) and the Common Electronic Data Interchange (CEDI) contractor. Additionally, this change request directs Shared Systems to appropriately update the CEM. Transmittal 1460, dated January 30, 2015, is being rescinded and replaced by Transmittal 1480 to remove edits X223.242.2300.HI01-2.050, X223.258.2300.HI01-2.020, X223.271.2300.HI01-2.020, X223.284.2300.HI01-2.020, and X222.239.2300.HI01-2.030 from the 837I, 837P, and CEDI spreadsheets. All other information remains the same.
Effective date: July 1, 2015
Implementation date: July 6, 2015
View Transmittal R1480OTN.
Removal of multiple NCDs using expedited process
On March 27, 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. Transmittal 180, dated March 6, 2015, is rescinded and replaced by Transmittal 181 to correct Section II on the transmittal page to indicate the manual sections are "Revised" and to correct the section statements in the manual instruction to indicate that each NCD is removed. The section numbers in the NCD manual are being retained for historical purposes. All other information remains the same.
Effective date: December 18, 2014
Implementation date: April 6, 2015
View Transmittal R181NCD.
View MLN Matters article MM9095.
Quarterly update to the CCI Edits, Version 21.2
On March 27, CMS released the normal update to the CCI procedure to procedure edits. The attached Recurring Update Notification applies to Pub. 100-04, Medicare Claims Processing Manual, Chapter 23, Section 20.9.
Effective date: July 1, 2015
Implementation date: July 6, 2015
View Transmittal R3222CP.
View MLN Matters article MM9108.
2014 Final Report & 2015 Expansion Project–CMS Focused Dementia Care Survey Pilot
On March 27, CMS posted a survey and certification letter outlining the basis for the Focused Dementia Care Survey Pilot, the process utilized, conclusions gathered based upon post-pilot data analysis, as well as next steps for the future. CMS plans to expand upon the work of the focused survey pilot and has invited states to conduct such surveys in FY2015 on a voluntary basis. The expansion project will involve a more intensive, targeted effort to improve surveyor effectiveness in citing poor dementia care and the overutilization of antipsychotic medications, and broaden the opportunities for quality improvement among providers. Deficient practices noted during the surveys will result in relevant citations. In the event additional care concerns are identified during on-site reviews, those concerns will be investigated during the survey or will be referred as a complaint for further review.
View the survey and certification letter.
Electronic Health Record Incentive Program-Stage 3
On March 30, CMS posted a Stage 3 proposed rule in the Federal Register that would specify the meaningful use criteria that eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) must meet in order to qualify for Medicare and Medicaid EHR incentive payments and avoid downward payment adjustments under Medicare for Stage 3 of the EHR Incentive Programs. It would continue to encourage electronic submission of clinical quality measure (CQM) data for all providers where feasible in 2017, propose to require the electronic submission of CQMs where feasible in 2018, and establish requirements to transition the program to a single stage for meaningful use. It would also change the EHR reporting period so all providers would report under a full calendar year timeline with a limited exception under the Medicaid EHR Incentive Program for providers demonstrating meaningful use for the first time. Comments are due by May 29.
View the notice in the Federal Register.
Leave a comment.
FDA approval of first biosimilar product
On March 30, CMS released a special edition MLN Matters article regarding the first biosimilar product approved by the FDA. CMS policies will ensure Medicare beneficiaries will have access to this new product, as it does for other drugs that receive FDA approval. The purpose of this article is to address questions that have arisen regarding biosimilar products.
View special edition MLN article SE1509.
Discontinued coverage of vacuum erection systems (VES) prosthetic devices in accordance with the Achieving a Better Life Experience Act of 2014
On March 30, CMS released a special edition MLN Matters article notifying suppliers of changes to the July DMEPOS Fee Schedule related to VES devices and instructs the DME MACs to implement changes to prohibit payment on claims for VES prosthetic devices (HCPCS L7900 and L7902) for dates of service on or after July 1, 2015.
View special edition MLN article SE1511.
Partial Hospitalization Program (PHP) claims coding & CY2015 per diem payment rates
On March 30, CMS released a special edition MLN Matters article alerting providers that the CMS issued the Calendar Year (CY) 2015 final corrected per diem payment rates for PHP services. See the Additional Information section of this article for specifics.
View special edition MLN Matters article SE1512.
Identifying “No Documentation” medical necessity denials for claims flagged for Recovery Auditor review
On March 30, CMS released a change request to provide a Recovery Audit specific "No documentation" reason code for MACs to append to prepayment claim denials. Transmittal 1462, dated February 6, 2015, is being rescinded and replaced by Transmittal 1483 to clarify the format of both the electronic report and file format discussed in this change request. All other information remains the same.
Effective date: July 1, 2015
Implementation date: July 6, 2015, for Define/Analyze and Design Application; October 5, 2015, for hours for Code Development/Test and Alpha Testing
View Transmittal R1483OTN.
April 2015 update of the ASC payment system
On April 1, CMS released a recurring update notification describing changes to billing instructions for various payment policies implemented in the April 2015 ASC payment system update. This recurring update notification applies to chapter 14, section 10. As appropriate, this notification also includes updates to HCPCS. Many ASC payment rates under the ASC payment system are established using payment rate information in the Medicare Physician Fee Schedule (MPFS). Transmittal 3214, dated March 11, 2015, is being rescinded and replaced by Transmittal 3225 to add Business Requirements 9100.13 and 9100.13.1, and to revise filename in Business Requirements 9100.2 and 9100.5. Also, CMS clarified its policy by removing the word “only” in the Policy sections B.1.a. and B.1.b. All other information remains the same.
Effective date: April 1, 2015
Implementation date: April 6, 2015
View Transmittal R3225CP.
View MLN Matters article MM9100.
Revisions to State Operations Manual (SOM) Appendices A, G, L and T related to hospitals, rural health clinics, ASCs and swing beds
On April 1, CMS released a change request revising the following appendices to reflect recent regulation changes: Appendix A, Survey Protocol, Regulations and Interpretive Guidelines for Hospitals, Appendix G, Guidance to Surveyors Rural Health Clinics, Appendix L, Guidance for Surveyors Ambulatory Surgical Centers, and Appendix T, Regulations and Interpretive Guidelines for Swing Beds in Hospitals. This change request makes clarifications and updates to existing guidance. Transmittal 136, dated March 27, 2015, is being rescinded and replaced by Transmittal 137 to correct the regulation number within the Appendix T Table of Contents Page. All other information remains the same.
Effective date: March 27, 2015
Implementation date: March 27, 2015
View Transmittal R137SOMA.
Extension of Probe and Educate and prohibition of RAC patient status reviews
On April 1, CMS posted on its Inpatient Hospital Reviews website that, given potential Congressional action on H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015, it will continue the Inpatient Probe and Educate process until April 30, 2015, and will continue to prohibit Recovery Auditor inpatient hospital patient status reviews for dates of admission occurring between October 1, 2013 and April 30, 2015. CMS believes the Inpatient Probe and Educate process has improved provider understanding of the 2-midnight policy. CMS believes this extension will allow for continued education and promote further understanding of the policy.
View the website.