This week in Medicare updates–04/06/2016
Reporting principal and interest amounts when refunding previously recouped money on the Remittance Advice (RA)
On March 24, CMS rescinded Transmittal 1570, dated November 6, 2015, and replaced it with Transmittal 1639 to update Attachment I. Also, the pre-implementation contact information has been changed. All other information remains the same.
Effective date: April 1, 2016, for analysis and design and July 1, 2016, for testing and final implementation, for FISS, HIGLAS, and A/B MACs; July 1, 2016, for MCS
Implementation date: April 4, 2016, for analysis and design and July 5, 2016, for testing and final implementation, for FISS, HIGLAS, and A/B MACs; July 5, 2016, for MCS
View Transmittal R1639OTN.
Changes to the laboratory NCD edit software for July 2016
On March 25, CMS released a transmittal announcing the changes that will be included in the July 2016 quarterly release of the edit module for clinical diagnostic laboratory services. The NCDs for clinical diagnostic laboratory services were developed by the laboratory negotiated rulemaking committee and the final rule was published on November 23, 2001. Nationally uniform software was developed and incorporated in the Medicare shared systems so that laboratory claims subject to one of the 23 NCDs (Publication 100-03, Sections 190.12-190.34) were processed uniformly throughout the nation effective April 1, 2003.
Effective date: July 1, 2016
Implementation date: July 5, 2016
View Transmittal R3485CP.
View MLN Matters article MM9584.
Completing and Processing Form CMS-1500 Data Set
On March 25, CMS released a change request to modify the current version of Internet Only Manual Pub. 100-04, Medicare Claims Processing Manual, Chapter 26—Completing and Processing Form CMS-1500 Data Set, Section 10.6—Carrier Instructions for Place of Service (POS), to modify existing information. Additional clarification of instructions was added to this chapter.
Effective date: April 25, 2016
Implementation date: April 25, 2016
View Transmittal R3484CP.
Revisions to the State Operations Manual (SOM) Chapter 9 exhibits
On March 25, CMS released a transmittal stating SOM Exhibit 356 was revised to include additional instructions.
Effective date: March 25, 2016
Implementation date: March 25, 2016
View Transmittal R153SOMA.
Revisions to the State Operations Manual (SOM) Chapter 2
On March 25, CMS released a transmittal including revisions to SOM Chapter 2, Sections 2779A and 2779A1. The revisions reflect the addition of new CMS Certification Numbers (CCN) State Codes. Simultaneous changes are being made to the CMS electronic payment systems.
Effective date: April 4, 2016
Implementation date: April 4, 2016
View Transmittal R152SOMA.
Guidance for the deployment of the Emergency Use Approval (EUA) Zika virus tests
On March 25, CMS provided guidance regarding the deployment of the EUA Zika virus tests, approved by CLIA, to state and local Public Health Laboratories (PHL) by the CDC. Two Zika virus tests with corresponding protocols have been developed by the CDC for use by state PHLs and have received EUA by the FDA. If test kits are noted during surveys, Regional Offices (RO) must confirm that the Zika Immunoglobulin M Antibody Capture Enzyme-Linked Immunosorbent Assay and/or the Trioplex Real Time RT-PCR Assay was verified by each laboratory per the CDC protocol, and that corresponding CLIA policies and procedures are in place to ensure readiness and compliance in the event of an outbreak. Upon receipt of the Zika virus test system and corresponding instructions and information, state PHLs will verify the developed test specifications in their laboratory per the CDC’s guidance.
View the survey and certification letter.
State Operations Manual (SOM) surveyor guidance revisions related to psychosocial harm in nursing homes
On March 25, CMS revised guidance to surveyors in Appendix PP of the SOM under F329 to enhance ease of use for surveyors and to include language related to how unnecessary use of medications may cause psychosocial harm to residents. CMS has revised language in the Psychosocial Outcome Severity Guide in Appendix P of the SOM. CMS has added language to selected F tags to emphasize the risk of psychosocial harm associated with noncompliance with specific regulations. The regulatory language remains unchanged.
View the survey and certification letter.
Hospices inappropriately billed Medicare more than $250 million for general inpatient care (GIP)
On March 31, the OIG posted a report stating hospices billed one-third of GIP stays inappropriately, costing Medicare $268 million in 2012. Hospices commonly billed for GIP when the beneficiary did not have uncontrolled pain or unmanaged symptoms.
View the report.
Enforcement of the Partial Hospitalization Program (PHP) 20 hours per week billing requirement
On March 31, CMS released a special edition MLN Matters article regarding enforcement editing requirements for the Medicare Benefit Policy Manual, (Internet-Only Manual 100-02) Chapter 6, and section 70.3, which describes coverage of PHP services. PHP providers should ensure billing staff is aware of these changes. This guidance updates the operational mechanism PHP providers should use to bill Medicare for PHP services furnished on or after July 1. New editing will be implemented in the July 2016 quarterly release of the Integrated Outpatient Code Editor. This advance notice is being given to assist PHP providers to prepare for these changes.
View special edition MLN Matters article SE1607.
Proposed collection; comment request
On April 1, CMS posted a notice in the Federal Register stating that it is accepting comments on: CMS–10545, Outcome and Assessment Information Set (OASIS) OASIS–C2/ICD–10; CMS–10309, Grandfathering Provisions of the Medicare DMEPOS Competitive Bidding Program; CMS–855(A, B, I), Medicare Enrollment Application; CMS–10468, Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes, and Premiums and Cost Sharing; Exchanges: Eligibility and Enrollment. Comments are due May 31.
View the notice in the Federal Register.
Leave a comment.
Kansas City Region 7 Fraud Symposium
CMS announced the Region 7 Fraud Symposium will promote Medicare and Medicaid fraud awareness for providers, medical office staff, and organizations that have direct contact with Medicare beneficiaries. Attendees will hear how Medicare fraud impacts them directly, how it impacts the medical practice, and the impact Medicare fraud has on the Medicare beneficiary. Attendees will also learn from local, regional, and national expects how to prevent, detect, and report fraud.
For more information or to register.
Advisory Panel on Hospital Outpatient Payment recommendations
On April 1, CMS added a document detailing the recommendations that were taken from the March 2016 meeting of the Advisory Panel on Hospital Outpatient Payment.
View the download.