This week in Medicare updates–01/20/2016
Accountable Care Organization Investment Model (AIM)
On January 11, CMS posted a fact sheet regarding the AIM. It is designed for organizations participating as ACOs in the Shared Savings Program. AIM is a model of pre-paid shared savings that builds on the experience with the Advance Payment ACO Model to encourage new ACOs to form in rural and underserved areas and current Shared Savings Program ACOs to transition to arrangements with greater financial risk. The model is expected to provide a total of $83 million in upfront and ongoing investments to AIM participants.
View the fact sheet.
CMS welcomes new Medicare Shared Savings Program participants and introduces Next Generation Accountable Care Organization Model (NGACO Model)
On January 11, CMS posted fact sheets announcing the selection of 100 new ACOs and 147 renewing ACOs that are joining, or continuing their participation in, the Medicare Shared Savings Program for the 2016 performance year. CMS also launched a new ACO model called the NGACO Model. Building on experience from the Pioneer ACO Model and the Medicare Shared Savings Program, through this new model CMS will partner with ACOs that are experienced in coordinating care for populations of patients whose provider groups are ready to assume higher levels of financial risk and reward.
View the fact sheet regarding new Shared Savings Program participants.
View the fact sheet regarding the NGACO Model.
CMS posts final guidance for reviewing short stay hospital claims for patient status
On January 11, CMS posted a final guidance for reviewing short stay hospital claims for patient status in Word format.
View CMS’ Inpatient Hospital Review page to access the document.
Notice of new interest rate for Medicare overpayments and underpayments—second quarter notification for FY 2016
On January 12, CMS released a transmittal updating the interest rate on overpayments and underpayments to Medicare providers. Interest is assessed on delinquent debts in order to protect the Medicare Trust Funds. The attached recurring update notification applies to Chapter 3, Medicare Financial Management Manual, section 10.
Effective date: January 19, 2016
Implementation date: January 19, 2016
View Transmittal R258FM.
New waived tests
On January 15, CMS released a change request informing contractors of new CLIA waived tests approved by the FDA. Since these tests are marketed immediately after approval, CMS must notify its contractors of the new tests so that the contractors can accurately process claims. There are 11 newly added waived complexity tests.
Effective date: April 1, 2016
Implementation date: April 4, 2016
View Transmittal R3440CP.
HCPCS codes subject to and excluded from CLIA edits
On January 15, CMS released a change request informing contractors about the new HCPCS codes for 2016 that are subject to and excluded from CLIA edits. This recurring update notification applies to Chapter 16, Medicare Claims Processing Manual, section 70.9.
Effective date: January 1, 2016
Implementation date: April 4, 2016
View Transmittal R3439CP.
Award of DME MAC contract for Jurisdiction D
On January 15, CMS released a change request to announce the award of the DME MAC Jurisdiction D contract to Noridian Healthcare Solutions, LLC, for the administration of Medicare DME Fee-for-Service claims
Effective date: September 14, 2015
Implementation date: March 1, 2016
View Transmittal R1592OTN.