This week in Medicare updates–03/09/2016
Coding revisions to NCDs
On February 26, CMS released a change request and multiple accompanying documents that serves as the sixth maintenance update of ICD-10 conversions and other coding updates specific to NCDs. The majority of the NCDs included are a result of feedback received from previous ICD-10 NCDs CR7818, CR8109, CR8197, CR8691, CR9087, and CR9252. Some are the result of revisions required to other NCD-related change requests released separately. Edits to ICD-10 and other coding updates specific to NCDs will be included in subsequent, quarterly releases as needed. No policy-related changes are included with these updates. Any policy-related changes to NCDs continue to be implemented via the current, long-standing NCD process.
Effective date: July 1, 2016
Implementation date: July 5, 2016
View the ZIP file containing Transmittal R1630OTN and the accompanying documents.
April 2016 hospital OPPS update
On February 26, CMS released a change request that describes changes to and billing instructions for various payment policies implemented in the April 2016 OPPS update. The April 2016 Integrated OCE (I/OCE) and OPPS Pricer will reflect the HCPCS, APC, HCPCS Modifier, and Revenue Code additions, changes, and deletions identified in this change request. This recurring update notification applies to Chapter 4, Medicare Claims Processing Manual, section 50.8. The April 2016 revisions to I/OCE data files, instructions, and specifications are provided in the forthcoming April 2016 I/OCE change request.
Effective date: April 1, 2016
Implementation date: April 4, 2016
View Transmittal R3471CP.
View MLN Matters article MM9549.
Agenda, presentations, and supporting documents for upcoming Advisory Panel on Hospital Outpatient Payment (HOP) meeting
On February 29, CMS posted documents pertaining to the upcoming HOP Panel meeting, scheduled to take place on March 14. The items are included in a ZIP file on CMS’ HOP Panel web page.
View the HOP Panel web page.
Program integrity enhancements to the provider enrollment process
On March 1, CMS posted a proposed rule in the Federal Register to implement processes in which providers and suppliers would be required to disclose certain current and previous affiliations with other providers and suppliers. This proposed rule would also provide CMS with additional authority to deny or revoke a provider’s or supplier’s Medicare enrollment. In addition, this proposed rule would require that to order, certify, refer, or prescribe any Part A or B service, item, or drug, a physician or, when permitted, an eligible professional must be enrolled in Medicare in an approved status or have validly opted out of the Medicare program. Comments are due April 25.
View the proposed rule in the Federal Register.
Leave a comment.
FY 2017 and after payments to long term care hospitals that do not submit required quality data
On March 4, CMS revised Pub. 100-22, Medicare Quality Reporting Incentive Programs, Chapter 3, section 60, to reflect changes to the payment reduction reconsideration process. It also includes general clarifications to the section. This change request rescinds and fully replaces CR9105.
Effective date: January 1, 2016
Implementation date: April 1, 2016
View Transmittal R55QRI.
Correcting amendments to Comprehensive Care for Joint Replacement (CJR) payment model for Acute Care Hospitals Furnishing Lower Extremity Joint Replacement Services
On March 4, CMS posted a correcting amendment in the Federal Register changing a limited number of technical and typographical errors identified in the November 24, 2015 final rule, called the CJR model. The changes are effective March 4.
View the notice in the Federal Register.
Correcting amendments to Electronic Health Record Initiative Program-Stage 3 and Modifications to Meaningful Use in 2015 Through 2017
On March 4, CMS posted a correcting amendment in the Federal Register changing certain technical and typographical errors that appeared in the October 16, 2015 final rule with comment period titled ‘‘Medicare and Medicaid Programs; Electronic Health Record Incentive Program—Stage 3 and Modifications to Meaningful Use in 2015 through 2017.” The changes are effective March 4.
View the notice in the Federal Register.
Proposed collection; comment request
On March 4, CMS posted a notice in the Federal Register stating that it is accepting comments on: CMS–10152, Data Collection for Medicare Beneficiaries Receiving NaF–18 Positron Emission Tomography (PET) To Identify Bone Metastasis in Cancer. Comments are due May 3.
View the notice in the Federal Register.
Leave a comment.
Better Care. Smarter Spending. Healthier People: Improving Quality and Paying for What Works
On March 3, CMS posted a fact sheet announcing that the administration estimates it has already hit its first quality or care target 11 months ahead of schedule: an estimated 30% of Medicare payments are tied to alternative payment models as of January 2016. This milestone was met when 121 new Accountable Care Organizations (ACO) joined the Medicare program on top of new participants in models such as the Bundled Payments for Care Improvement Initiative and Comprehensive Primary Care Initiative. The shift towards quality and value is intended to help patients receive, and doctors and other clinicians provide, the best care possible.
View the fact sheet.
Overview of Select Alternative Payment Models
On March 3, CMS posted a fact sheet that offers an overview of the 10 alternative payment models that contribute to progress towards the agency’s goal of tying 30% of traditional, or fee-for-service, Medicare payments to quality or value.
View the fact sheet.