This week in Medicare updates–1/11/2017
CMS Publishes Cardiac Rehabilitation Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model (CJR)
On January 3, CMS published a Final Rule in the Federal Register to implement three new Medicare Parts A and B episode payment models, a Cardiac Rehabilitation (CR) Incentive Payment model and modifications to the existing Comprehensive Care for Joint Replacement model. This rule is effective February 18, 2017, except for certain specific provisions listed in the final rule.
Additional Guidance for Clinical Laboratories as Data Reporting Begins
On January 4, CMS posted Special Edition MLN Matters 17002 to provide additional guidance to the laboratory community in meeting the new requirements under Section 1834A of the Social Security Act for the Medicare Part B Clinical Laboratory Fee Schedule. The data reporting period opened on January 1, 2017. CMS has developed an online data collection system to assist laboratories in submitting data to CMS, which are due by March 31, 2017.
Medicare Compliance Review of Abbott Northwestern Hospital for 2013 and 2014
On January 5, the OIG published a Report regarding Abbott Northwestern Hospital, which complied with Medicare billing requirements for 88 of the 162 inpatient and outpatient claims reviewed by the OIG. This resulted in overpayments of $934,000 for 2013 and 2014. On the basis of the sample results, the OIG estimates that the hospital received overpayments of at least $8 million for the audit period.
Revised CMS 855S Application – Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers
On January 5, CMS posted Special Edition MLN Matters 17004 regarding the revised CMS 855S application, which simplifies and clarifies the current data collection and removes obsolete and/or redundant data collection. DMEPOS suppliers that they must use the revised CMS-855S application beginning December 31, 2016.