This week in Medicare updates–01/13/2016
FY 2016 IPPS and long term care hospital (LTCH) PPS changes
On December 29, 2015, CMS rescinded Transmittal 3373, dated October 14, 2015, and replaced it with Transmittal 3431 to add CardioMEMS™ HF Monitoring System to the list of items approved for a New Technology Add-On Payment and to renumber the list. All other information remains the same.
Effective date: October 1, 2015
Implementation date: October 5, 2015
View Transmittal R3431CP.
View MLN Matters article MM9253.
View Transmittal R3431CP1 for a zip file.
NCD for screening for colorectal cancer using Cologuard™–A Multitarget Stool DNA test
On December 30, 2015, CMS rescinded Transmittal 3319, dated August 6, 2015, and replaced it with Transmittal 188 to show that HCPCS code G0464 (colorectal cancer screen; stool-based DNA and fecal occult hemoglobin) expired on December 31, 2015, and is replaced in the 2016 Clinical Laboratory Fee Schedule with CPT code 81528. All other information remains the same.
Effective date: October 9, 2014
Implementation: September 8, 2015, for non-shared MAC edits; January 4, 2016, for all shared system changes
View Transmittal R188NCD.
View MLN Matters article MM9115.
Clarification on Patient’s Reason for Visit necessary to capture HIPAA compliant fields
On December 31, 2015, CMS released a transmittal to clarify the usage of the Patient's Reason for Visit field in order for Medicare to process HIPAA compliant claim information located on the UB-04, or 837I transactions, of the claim form.
Effective date: July 1, 2015
Implementation date: March 31, 2016
View Transmittal R3435CP.
View MLN Matters article MM9450.
Rural health clinic and federally qualified health center–Medicare Benefit Policy Manual update
On December 31, 2015, CMS released a transmittal stating that Chapter 13 of the Benefit Policy Manual has been updated to include information on payment for chronic care management services, payment for Grandfathered Tribal Federally Qualified Health Centers, removal of obsolete provisions, and reorganization of some sections.
Effective date: February 1, 2016
Implementation date: February 1, 2016
View Transmittal R217BP.
View MLN Matters article MM9442.
Reorganization of Medicare Claims Processing Manual, Chapter 9, Rural Health Clinics (RHC) and Federally Qualified Health Centers (FQHC)
On December 31, 2015, CMS released a transmittal stating that Chapter 9 of the Medicare Claims Processing Manual has been reorganized and updated.
Effective date: March 31, 2016
Implementation date: March 31, 2016
View Transmittal R3434CP.
View MLN Matters article MM9397.
Clinical laboratory fee schedule–Medicare travel allowance fees for collection of specimens
On December 31, 2015, CMS released a change request revising the payment of travel allowances when billed on a per mileage basis using HCPCS code P9603 and when billed on a flat rate basis using HCPCS code P9604 for CY 2016.
Effective date: January 1, 2016
Implementation date: February 1, 2016
View Transmittal R3433CP.
View MLN Matters article MM9485.
Affordable Care Act Bundled Payments for Care Improvement Initiative–recurring file updates Models 2 and 4, April 2016 updates
On December 31, 2015, CMS released a change request updating the participating hospital files, episodes, and prospective bundled payment amounts associated with the Bundled Payments for Care Improvement initiative, Model 2 and Model 4. The number for this recurring update is R21662Q.
Effective date: April 1, 2016
Implementation date: April 4, 2016
View Transmittal R135DEMO.
2016 DME, prosthetics, orthotics, and supplies HCPCS code jurisdiction list
On December 31, 2015, CMS released a transmittal containing an updated list of the HCPCS codes for DME MAC and Part B MAC jurisdictions which is updated annually to reflect codes that have been added or discontinued. This recurring update notification applies to Chapter 23, Medicare Claims Processing Manual, section 20.3.
Effective date: January 1, 2016
Implementation date: February 1, 2016
View Transmittal R3432CP.
View MLN Matters article MM9481.
OIG Advisory Opinions No. 15-16 and 15-17
On January 4, the OIG posted responses to a request for an advisory opinion regarding a nonprofit, tax-exempt, charitable organization’s proposal to provide assistance with out-of-pocket expenses for outpatient prescription drugs to financially needy insured patients, including, but not limited to, Medicare and Medicaid beneficiaries.
View Opinion 15-16.
View Opinion 15-17.
January 2016 Integrated OCE (I/OCE) specifications version 17.0
On January 6, CMS rescinded Transmittal 3427, dated December 18, 2015, and replaced it with Transmittal 3437 to update the Summary of Quarterly Release Modifications and Summary of Data Changes attachments. All other information remains the same.
View Transmittal R3437CP.
Notice of modification of OIG Advisory Opinion No. 04-15
On January 6, the OIG posted a modification to Opinion 04-15 regarding operating a patient assistance program to provide grants to financially needy patients suffering from specific chronic or life-threatening diseases to defray costs of prescription drug therapies.
View the modified opinion.
View the modified opinion.
CY 2016 eligibility changes to the ESRD PPS Low-Volume Payment Adjustment (LVPA)
On January 8, CMS released a change request providing guidance to MACs on the changes made to the LVPA eligibility criteria effective January 1.
Effective date: January 1, 2016
Implementation date: January 22, 2016
View Transmittal R218BP.
Emergency update to the CY 2016 Medicare Physician Fee Schedule Database (MPFSDB)
On January 8, CMS released a change request stating that payment files were issued to contractors based on the CY 2016 Medicare Physician Fee Schedule Final Rule. This change request amends those payment files in order to correct technical errors to the MPFS update files, and to include corrections described in the CY 2016 MPFS final rule correction notice. Please note that the work related to this change request has already been done by Medicare contractors via a previous direction, which was implemented on January 4. Therefore, the implementation date is prior to the release date of this change request.
Effective date: January 1, 2016
Implementation date: January 4, 2016
View Transmittal R3438CP.
Changes to Medicare EHR Incentive Program payment adjustment beginning January 1
On January 8, CMS released a change request to detail changes in systems and processes affected by the implementation of the second year of the Medicare EHR Incentive Program payment adjustment beginning January 1 for eligible professionals.
Effective date: January 1, 2016
Implementation date: January 4, 2016
View Transmittal R1591OTN.
January 2016 Medicare Quarterly Provider Compliance newsletter
CMS posted its January 2016 issue of Medicare Quarterly Provider Compliance newsletter, which addresses common Recovery Audit and Comprehensive Error Rate Testing findings that impact physicians, non-physician practitioners, DME suppliers, inpatient psychiatric hospitals, and outpatient providers.
View the newsletter.