This week in Medicare updates - 9/30/2015
Claims processing Medicare Secondary Payer (MSP) policy and procedures regarding ongoing responsibility for medicals (ORM)
On September 18, CMS rescinded Transmittal 3213, dated March 6, 2015, and replaced it with Transmittal 3358 to include the CWF newly defined MSP maintenance transaction error codes. Additionally, for each Internet Only Manual chapter and section included in this transmittal, CMS is adding a URL link to the CWF maintenance documentation. All other information remains the same.
Effective date: July 1, 2015; October 1, 2015
Implementation: July 6, 2015, for design and pre-coding (CWF, FISS, and VMS); October 5, 2015, for full implementation (CWF, FISS, MCS, and VMS)
View Transmittal R3358CP.
Maintenance and update of the temporary hook created to hold OPPS claims that include certain drug HCPCS codes
On September 18, CMS released a transmittal stating that certain drug HCPCS codes updated quarterly will not have the new drug prices included in the OPPS Pricer. Claims for dates of service falling under the new OPPS Pricer that include one or more drug HCPCS codes from the file, found at the address specified in the Business Requirements, are to be held by the A/B MAC until a revised OPPS Pricer is installed in their production region. OPPS Pricer installation deadlines are included in the OPPS Pricer schedule.
Effective date: January 1, 2016
Implementation: January 4, 2016
View Transmittal R3356CP.
Annual Medicare Physician Fee Schedule (MPFS) files delivery and implementation
On September 18, CMS released a transmittal stating that the MPFS Files are released annually to the Medicare contractors. This instruction is to give direction of the notification and implementation of the annual MPFS Files. The attached recurring update notification applies to Chapter 1, Medicare Claims Processing Manual, section 30.3.12.1.2.
Effective date: January 1, 2016
Implementation: January 4, 2016
View Transmittal R3355CP.
Provider Reimbursement Manual Part 2, Provider Cost Reporting Forms and Instructions, Chapter 40, Form CMS-2552-10
On September 18, CMS released a transmittal updating Chapter 40, Hospital and Hospital Health Care Complex Cost Report, (Form CMS-2552-10) to clarify and correct the existing instructions and incorporate statutory and regulatory changes.
Effective date: Cost Reporting periods beginning on or after June 30, 2015
View Transmittal R8P240.
January 2016 Quarterly Average Sales Price (ASP) Medicare Part B drug pricing files and revisions to prior quarterly pricing files
On September 18, CMS released a transmittal stating the ASP methodology is based on quarterly data submitted to CMS by manufacturers. CMS will supply contractors with the ASP and not otherwise classified drug pricing files for Medicare Part B drugs on a quarterly basis. Payment allowance limits under the OPPS are incorporated into the Outpatient Code Editor through separate instructions that can be located in Chapter 4, Medicare Claims Processing Manual, section 50 of the IOM.
Effective date: January 1, 2016
Implementation: January 4, 2016
View Transmittal R3354CP.
View MLN Matters article MM9351.
Quarterly update to the CCI Edits, Version 22.0
On September 18, 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: January 1, 2016
Implementation: January 4, 2016
View Transmittal R3353CP.
View MLN Matters article MM9326.
Moving Medicare Advantage and Part D forward
On September 21, CMS released a fact sheet stating Medicare Advantage and Part D will continue to provide greater protections for beneficiaries and value for taxpayers and detailing all the changes and progressions.
View the fact sheet.
View the press release.
Implementation of Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) based on specific clinical criteria
On September 22, CMS rescinded Transmittal 1513, dated June 24, 2015, and replaced it with Transmittal 1544 to:
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Remove the sensitive and controversial status,
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Remove the ‘NOTE’ in business requirements 9015.7 and 9015.8,
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Revise the ‘NOTE’ in business requirement 9015.11,
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Replace references of psychiatric/rehabilitative diagnosis to specified psychiatric/rehabilitation DRG,
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Replace references of ventilation DRG to specified ventilation procedure code
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Update business requirements 9015.15 and 9015.16 to remove patient status codes ‘63’ and ‘91’ and add applicable second position return codes.
All other information remains the same.
Effective date: Discharges in cost reporting periods beginning on or after October 1, 2015
Implementation date: July 6, 2015; October 5, 2015
View Transmittal R1544OTN.
View MLN Matters article MM9015.
October 2015 Integrated Outpatient Code Editor (I/OCE) specifications version 16.3
On September 23, CMS rescinded Transmittal 3328, dated August 14, 2015, and replaced it with Transmittal 3359 to attach an updated Summary of Data Changes and Appendix O. All other information remains the same.
Effective date: October 1, 2015
Implementation: October 5, 2015
View Transmittal R3359CP.
View MLN Matters article MM9290.
Adjustment to the amount in controversy (AIC) threshold amounts for calendar year (CY) 2016
On September 25, CMS posted a notice in the Federal Register announcing the annual adjustment in the AIC threshold amounts for Administrative Law Judge (ALJ) hearings and judicial review under the Medicare appeals process. The adjustment to the AIC threshold amounts will be effective for requests for ALJ hearings and judicial review filed on or after January 1, 2016. The CY 2016 AIC threshold amounts are $150 for ALJ hearings and $1,500 for judicial review. This notice is effective on January 1, 2016.
View the notice in the Federal Register.
Partnership for Patients and Hospital Engagement Networks: Continuing forward momentum on reducing patient harm
On September 25, CMS released a fact sheet announcing that it awarded $110 million to 17 national, regional, or state hospital associations and health system organizations to serve as the second round of Hospital Engagement Networks. The period of performance for this second round of Hospital Engagement Networks is one year and begins in September 2015. The contracts are part of the Partnership for Patients, a nationwide public-private collaboration to keep patients from being harmed while in the hospital and heal without complication once they are discharged.
View the fact sheet.
View the press release.