This week in Medicare updates
Comprehensive Error Rate Testing (CERT) Program treatment of power mobility device (PMD) and Repetitive Scheduled Non-Emergent Ambulance Transport claims
On May 22, CMS released a change request to update the Program Integrity Manual, Chapter 12 with instructions on how the CERT program will handle PMDs and Repetitive Schedule Non-Emergent Ambulance Transport prior authorization model claims that are selected as part of the CERT sample.
Effective date: June 23, 2015
Implementation date: June 23, 2015
View Transmittal R595PI.
IPPS hospital extensions per the Medicare Access and CHIP Reauthorization Act of 2015
On May 22, CMS released a change request providing information and implementation instructions for Sections 204 and 205 of the Medicare Access and CHIP Reauthorization Act of 2015. The attached Recurring Update Notification applies to chapter 3, section 20.3.4.
Effective date: April 1, 2015
Implementation date: July 6, 2015
View Transmittal R3263CP.
View MLN Matters article MM9197.
July 2015 Integrated Outpatient Code Editor (I/OCE) specifications version 16.2
On May 22, CMS released a change request providing the Integrated OCE instructions and specifications for the Integrated OCE that will be used under the OPPS and Non-OPPS for hospital outpatient departments, community mental health centers, all non-OPPS providers, and for limited services when provided in a home health agency not under the Home Health Prospective Payment System or to a hospice patient for the treatment of a non-terminal illness. The attached Recurring Update Notification applies to 100-04, Medicare Claims Processing Manual, Chapter 4, section 40.1.
Effective date: July 1, 2015
Implementation date: July 6, 2015
View Transmittal R3264CP.
View MLN Matters article MM9190.
New waived tests
On May 22, 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 7 newly added waived complexity tests. This recurring update notification applies to Chapter 16, Medicare Claims Processing Manual, section 70.8 of the Internet-Only Manual, IOM.
Effective date: July 1, 2015
Implementation date: July 6, 2015
View Transmittal R3267CP.
Microvolt T-wave alternans (MTWA)
On May 22, CMS released two change requests regarding the removal of national non-coverage of the modified moving average (MMA) method, leaving Medicare coverage of MTWA using MMA and methods of analysis other than spectral analysis for the evaluation of patients at risk for sudden cardiac death from ventricular arrhythmias to be determined by the local MACs. This revision to the Medicare National Coverage Determinations Manual is a national coverage determination.
Effective date: January 13, 2015
Implementation date: June 23, 2015
View Transmittal R3265CP.
View Transmittal R182NCD.
Review and status of nursing home survey: Summary of traditional and quality indicator survey (QIS) findings and issues
On May 22, CMS posted a survey and certification letter regarding a review of both the traditional survey and QIS processes used to access nursing home quality. CMS is continuing to make improvements to QIS to address the challenges, concerns and feedback received to optimize the effectiveness and efficiency of survey process.
View the survey and certification letter.
Cox Medical Center incorrectly billed Medicare inpatient claims with Kwashiorkor
On May 27, the OIG posted a report stating Cox Medical Center in Branson, Missouri did not comply with Medicare requirements for billing Kwashiorkor on any of the 59 claims it reviewed. The hospital used diagnosis code 260 for Kwashiorkor but should have used codes for other forms of malnutrition or no malnutrition code at all. For 21 of the inpatient claims, substituting a more appropriate diagnosis code produced no change in the payment amount. However, for the remaining 38 inpatient claims, the errors resulted in overpayments of $123,000. Hospital officials attributed these errors to problems with the software used to code the diagnoses.
View the report.
FY 2015 HHS OIG Work Plan Mid-Year Update
On May 28, the OIG posted its Work Plan Mid-Year Update for Fiscal Year 2015, which summarizes new and ongoing reviews and activities that OIG plans to pursue with respect to HHS programs and operations during the current fiscal year and beyond. This edition removes items that have been completed, postponed, or canceled and includes new items that have been started since October 2014.
View the 2015 Work Plan Mid-Year Update.
Million Hearts®: Cardiovascular Disease (CVD) Risk Reduction model
On May 28, CMS released a fact sheet regarding the Million Hearts® CVD Risk Reduction model, which proposes an innovative way of lowering the risks of suffering heart attacks or strokes. The model incentivizes practices to calculate risk for all eligible Medicare beneficiaries by using the American College of Cardiology/American Heart Association Atherosclerotic CVD 10-year pooled cohort risk calculator and to develop risk modification plans based on beneficiary risk profiles.
View the fact sheet.
Quarterly update to the NCCI Edits, Version 21.3, Effective October 1, 2015
On May 29, CMS released a normal update to the National Correct Coding Initiative (NCCI) 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: October 1, 2015
Implementation date: October 5, 2015
View Transmittal R3275CP.
View the NCCI website.
Quarterly update of HCPCS codes used for home health consolidated billing enforcement
On May 29, CMS released a change request providing the October quarterly update to the list of HCPCS codes used by Medicare systems to enforce consolidated billing of home health services. The attached recurring update notification applies to Chapter 10, Medicare Claims Processing Manual, section 20.
Effective date: October 1, 2015
Implementation date: October 5, 2015
View Transmittal R3269CP.
Corrections to the 2015 Home Health (HH) Pricer program
On May 29, CMS released a change request to instruct MACs to install a new HH Pricer program. The new Pricer contains updates to allow processing of type of bill 032Q or 033Q, as required by Change Request 8581. It also corrects errors affecting the payments on 2015 claims and instructs the MACs to adjust claims in order to correct payment amounts.
Effective date: January 1, 2015
Implementation date: October 5, 2015
View Transmittal R3268CP.
July 2015 quarterly update of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule
On May 29, CMS released a change request to rescind and replace Transmittal 3257, dated May 15, 2015, with Transmittal 3277 to remove Part B MAC responsibility for Business Requirements 9177.4–9177.5. All other information remains the same. These transmittals are regarding the quarterly update of the DMEPOS Fee Schedule.
Effective date: January 1, 2015, for implementation of fee schedule amounts for codes in effect January 1, 2015; July 1, 2015 for all other changes
Implementation date: July 6, 2015
View Transmittal R3277CP.
Instructions for downloading the Medicare ZIP Code File for October 2015
On May 29, CMS released a change request to provide instruction for updating the two Medicare ZIP Code files (ZIP5 and ZIP9) for the October 2015 quarter. The attached recurring update notification applies to Chapter 15, Medicare Claims Processing Manual, section 20.1.5 (B).
Effective date: October 1, 2015
Implementation date: October 5, 2015
View Transmittal R3276CP.
Claim Status category and Claim Status codes update
On May 29, CMS released a change request to update as needed the Claim Status and Claim Status Category Codes used for the Accredited Standards Committee (ASC) X12 276/277 Healthcare Claim Status Request and Response and ASC X12 277 Healthcare Claim Acknowledgment transactions. These code sets are updated at the Code Committee meeting held in conjunction with the ASC X12 meetings three times per year: January/February, June, and September/October. The Committee has decided to allow the industry six months for implementation of newly added or changed codes. Contractors are to use the codes that will be posted at www.wpc-edi.com/codes on or about July 1, 2015, the will be listed as current codes on that site. This recurring update notification can be found in Chapter 31, Medicare Claims Processing Manual, section 20.7.
Effective date: October 1, 2015
Implementation date: October 5, 2015
View Transmittal R3272CP.
Meeting of the Advisory Panel on Outreach and Education (APOE)
On May 29, CMS posted a notice in the Federal Register announcing a meeting of the Advisory Panel on Outreach and Education (APOE) (the Panel) in accordance with the Federal Advisory Committee Act. The Panel advises and makes recommendations to the secretary of the HHS and the administrator CMS on opportunities to enhance the effectiveness of consumer education strategies concerning the Health Insurance Marketplace, Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). The meeting will be held Thursday, June 25, from 8:30 a.m. to 4:00 p.m. Eastern. This meeting is open to the public.
View the notice in the Federal Register.