This week in Medicare updates–10/28/2015
Medicare Open Enrollment starts today
On October 15, CMS posted a press release announcing the beginning of the Medicare Open Enrollment period where people with Medicare can shop for a Medicare Advantage or Prescription Drug Plan for 2016. The Medicare Open Enrollment period happens every year from October 15 through December 7.
View the press release.
January 2016 quarterly update for the DME, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program (CBP)
On October 16, CMS released the updated DME CBP files, which is done on a quarterly basis to implement necessary changes to the HCPCS, ZIP code, Single payment amount, and Supplier files. These requirements provide specific instruction for implementing the DMEPOS CBP files. The recurring update notification applies to Chapter 23, Medicare Claims Processing Manual, section 100.
Effective date: January 1, 2016
Implementation date: January 4, 2016
View Transmittal R3377CP.
View MLN Matters article MM9383.
Additional G-codes differentiating registered nurses (RN) and LPNs in the home health and hospice settings
On October 16, CMS released a change request creating new codes to distinguish whether an RN or an LPN provided hospice or home health services.
Effective date: January 1, 2016
Implementation date: January 1, 2016
View Transmittal R3378CP.
View MLN Matters article MM9369.
Program Integrity Manual, Chapter 3 updates-Section 3.2.3.2 Timeframes for Submission and section 3.2.3.8-No Response or Insufficient Response to Additional Documentation Requests
On October 16, CMS released a change request to extend the due date for submitted documentation from providers, requested by the MACs, Comprehensive Error Rate Testing (CERT) and Recovery Auditors in Chapter 3 of Pub. 100-08, Program Integrity Manual.
Effective date: November 17, 2015
Implementation date: November 17, 2015
View Transmittal R620PI.
Expansion of Prior Authorization Model for Repetitive Scheduled Non-Emergent Ambulance Transport
On October 20, CMS posted a notice in the Federal Register announcing an expansion of the three-year Medicare Prior Authorization Model for Repetitive Scheduled Non-Emergent Ambulance Transport in accordance with section 515(a) of the Medicare Access and CHIP Reauthorization Act of 2015. The model is being expanded to the states of Maryland, Delaware, the District of Columbia, North Carolina, West Virginia, and Virginia beginning on January 1, 2016.
View the notice in the Federal Register.
OIG Advisory Opinion No. 15-13
On October 21, the OIG posted an advisory opinion regarding a plan to offer free van shuttle service to certain medical facilities in an integrated health system.
View the advisory opinion.
Vibra Hospital incorrectly billed Medicare inpatient claims with Kwashiorkor
On October 23, the OIG posted a report stating Vibra Hospital did not comply with Medicare requirements for billing Kwashiorkor on any of the 92 claims reviewed. The hospital used diagnosis code 260 for Kwashiorkor but should have billed for other forms of malnutrition or no malnutrition at all. For five of the inpatient claims, substituting a more appropriate diagnosis code produced no change in the payment amount. For the remaining 87 inpatient claims, the errors resulted in overpayments of $584,000. Hospital officials attributed this to errors made by a former owner of the hospital and to a lack of clarity in the coding guidelines.
View the report.
Kindred Hospital of Central Ohio incorrectly billed Medicare inpatient claims with Kwashiorkor
On October 23, the OIG posted a report stating Kindred Hospital of Central Ohio did not comply with Medicare requirements for billing Kwashiorkor on any of the 77 claims reviewed. The hospital used diagnosis code 260 for Kwashiorkor but should have billed for other forms of malnutrition or no malnutrition at all. For 66 of the inpatient claims, substituting a more appropriate diagnosis code produced no change in the payment amount. For the remaining 11 inpatient claims, the errors resulted in overpayments of $62,000. Hospital officials attributed these errors to a former owner of the hospital and to a lack of clarity in the coding guidelines.
View the report.