This week in Medicare updates – 10/21/2015
CMS launches new ACO dialysis model
On October 7, 2015, CMS announced the new accountable care organization (ACO) dialysis model, the Comprehensive ESRD Care (CEC) Model, participants.
The CEC Model is designed specifically for beneficiaries with ESRD and builds on experiences from other models and programs with ACOs, including the Pioneer ACO Model and the Medicare Shared Savings Program. In the CEC Model, dialysis facilities, nephrologists, and other providers have joined together to form ESRD Seamless Care Organizations (ESCO) to coordinate care for ESRD beneficiaries. This model will encourage dialysis providers to think beyond their traditional roles in care delivery and support beneficiaries as they provide patient-centered care that will address beneficiaries’ health needs in and out of the dialysis facility.
Read the press release.
New Medicare utilization and payment data available for medical equipment, supplies
On October 8, 2015, CMS posted a press release regarding the availability of new Medicare utilization and payment data for medical equipment and supplies.
CMS has posted a new data set as part of the Provider Utilization and Payment files. This data set, called Referring Provider Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Public Use File (PUF), provides information on physicians and other healthcare professionals who referred DMEPOS products and services, such as wheelchairs, walkers, and diabetes supplies for Medicare beneficiaries.
Read the press release.
View a fact sheet on the Referring Provider DMEPOS PUF. .
Implementing transmittal for FY2016 IPPS and LTCH PPS
On October 14, CMS published Transmittal 3373 with the implementing instructions for FY2016 IPPS payment and policy changes. The transmittal is available in a downloadable zip file with several other files containing policy related tables. The transmittal contains corrections and updates from a prior confidential version that was not publicly available.
Effective Date: October 1, 2015
Implementation Date: October 5, 2015
View the CMS website to download the transmittals and attachments.
Written Orders Prior to Delivery (WOPD) for specified DME
On October 9, 2015, CMS posted Transmittal 618 to provide new instructions for WOPD for power operated vehicles, power wheelchairs, and certain covered durable medical equipment (DME) items. The CR also provides specific date and timing requirements.
Effective Date: November 10, 2015
Implementation Date: November 10, 2015
View Transmittal 618.
Frontier Community Health Integration Project (FCHIP) implementing transmittal
On October 9, 2015, CMS posted Transmittal 123, which implements FCHIP payment changes.
Section 123 of the Medicare Improvements for Providers and Patients Act of 2008 authorizes a demonstration project on community health integration models in certain rural counties to develop and test new models for the delivery of healthcare to better integrate the delivery of acute care, extended care, and other healthcare, thereby improving access to care for Medicare and Medicaid beneficiaries located in very sparsely populated areas. CMS will be modifying Medicare payment rules for specified Critical Access Hospitals (CAH) and ambulance services in the following three States: Montana, Nevada, and North Dakota.
CMS will select the participating CAHs prior to January 1, 2016. CMS will identify for the Medicare Administrative Contractor (MAC) all providers that will be subject to the respective payment changes for ambulance services, long-term care services, and cost-based reimbursement for telehealth services.
Effective Date: January 1, 2016
Implementation Date: January 1, 2016
View Transmittal 123.
CMS clarifies terms implicating a Spousal Relationship in Certification Manual
On October 9, 2015, CMS posted Transmittal 149 to provide clarification to all providers and suppliers subject to certification as to the meaning of the terms "marriage," "spouse," and other terms that implicate the spousal relationship wherever used in the appendices.
Effective Date: October 9, 2015
Implementation Date: October 9, 2015
View Transmittal 149.
State Operations Manual exhibits related to provider terminations updated
On October 9, 2015, CMS posted Transmittal 148 revising SOM Chapter 9 exhibits that reflect changes in procedures for submitting appeals to the Departmental Appeals Board (DAB). The exhibits relate to termination of provider status or other adverse survey determinations.
Effective Date: October 9, 2015
Implementation Date: October 9, 2015
View Transmittal 148.
Notification of 1st Quarter FY 2016 interest rate for overpayments and underpayments
On October 13, 2015, CMS posted Transmittal 255 providing notice of the new interest rate for Medicare over- and underpayments for the first quarter of 2016. Interest is assessed on delinquent debts to protect the Medicare Trust Funds.
Effective Date: October 20, 2015
Implementation Date: October 20, 2015
View Transmittal 255.
2015 Edition Health Information Technology (Health IT) Certification Criteria, 2015 Edition Base Electronic Health Record (EHR) Definition, and ONC Health IT Certification program modifications
On October 16, 2015, HHS ONC posted a final rule regarding the certification criteria while also modifying the ONC Health IT Certification Program to make it open and accessible to more types of health IT and health IT that supports various care and practice settings. The 2015 Edition establishes the capabilities and specifies the related standards and implementation specifications that Certified Electronic Health Record Technology (CEHRT) would need to include to, at a minimum, support the achievement of meaningful use by eligible professionals (EP), eligible hospitals, and critical access hospitals (CAH) under the Medicare and Medicaid EHR Incentive Programs (EHR Incentive Programs) when such edition is required for use under these programs.
Effective Date: January 14, 2016, except for § 170.523(m) and (n), which are effective April 1, 2016.
View the notice in the Federal Register.
Medicare and Medicaid programs; Electronic Health Record Incentive Program—Stage 3 and Modifications to Meaningful Use in 2015 through 2017
On October 16, CMS posted a final rule with comment period in the Federal Register regarding the requirements that eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAH) must meet to qualify for Medicare and Medicaid electronic health record (EHR) incentive payments and avoid downward payment adjustments under the Medicare EHR Incentive Program. In addition, this final rule with comment period establishes the requirements for Stage 3 of the program as optional in 2017 and required for all participants beginning in 2018. The final rule with comment period continues to encourage the electronic submission of clinical quality measure (CQM) data, establishes requirements to transition the program to a single stage, and aligns reporting for providers in the Medicare and Medicaid EHR Incentive Programs. Comments are due December 15, 2015.
Effective Date: December 15, 2015.
View the notice in the Federal Register.
October 2015 Medicare Quarterly Provider Compliance Newsletter
CMS recently posted its October 2015 MLN Matters Medicare Quarterly Provider Compliance Newsletter. The publication discusses Recovery Auditor findings regarding acute hospital readmissions without Condition Code B4 or 42, exact duplicate professional claims, and multiple surgeries. It also discusses Comprehensive Error Rate Testing (CERT) findings related to referring providers/third-party documentation, lower limb prosthetics, and frequency limitations on services.