This week in Medicare updates–03/16/2016

March 15, 2016

Medicare Insider

July quarterly update to 2016 annual update of HCPCS codes used for SNF Consolidated Billing (CB) enforcement

On March 4, CMS posted a transmittal providing updates to the lists of HCPCS codes that are subject to the consolidated billing provision of the SNF PPS. Changes to CPT/HCPCS codes and Medicare Physician Fee Schedule designations will be used to revise CWF edits to allow MACs to make appropriate payments in accordance with policy for SNF consolidated billing in Chapter 6, Medicare Claims Processing Manual, section 20.6.

View Transmittal R3473CP.

View MLN Matters article MM9561.

Updates to Pub. 100-04, Medicare Claims Processing Manual, Chapters 4 and 5 to correct remittance advice messages

On March 4, CMS posted a change request revising Chapters 4 and 5 of the Medicare Claims Processing Manual to ensure that all remittance advice coding is consistent with nationally standard operating rules. It also provides a format for consistently showing remittance advice coding throughout this manual.

View Transmittal R3475CP.

View MLN Matters article MM9424.

Correction to Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2016

On March 8, CMS posted a document in the Federal Register correcting technical and typographical errors that appeared in the final rule with comment period published in the November 16, 2015 Federal Register (80 FR 70886 through 71386) entitled ‘‘Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2016.’’ Corrections are effective March 7.

View the notice in the Federal Register.

Medicare SNF transparency data (CY 2013)

On March 9, CMS released a new dataset, the Skilled Nursing Facility Utilization and Payment Public Use File (SNF PUF). This data set, which is part of CMS’s Medicare Provider Utilization and Payment Data sets, details information on services provided to Medicare beneficiaries by SNFs. The new data include information on 15,055 SNFs, more than 2.5 million stays, and almost $27 billion in Medicare payments for 2013. The data is posted on the CMS website.

View the fact sheet.

View the press release.

Medicare Compliance Review of Freeman Hospital for 2011 and 2012

On March 10, the OIG posted a report stating that Freeman Hospital, operating in Joplin, Missouri, complied with Medicare billing requirements for 180 of the 225 inpatient and outpatient claims reviewed. However, the hospital did not fully comply with Medicare billing requirements for the remaining 45 claims, resulting in overpayments of $311,000. Specifically, 42 inpatient claims had billing errors, resulting in overpayments of $304,000, and three outpatient claims had billing errors, resulting in overpayments of $7,000. These errors occurred primarily because the hospital did not have adequate controls to prevent the incorrect billing of Medicare claims within the selected risk areas that contained errors.

View the report.

Part B Drug Payment Model

On March 11, CMS posted a proposed rule in the Federal Register discussing the implementation of a new Medicare payment model under section 1115A of the Social Security Act. CMS proposes the Part B Drug Payment Model as a two-phase model that would test whether alternative drug payment designs will lead to a reduction in Medicare expenditures, while preserving or enhancing the quality of care provided to Medicare beneficiaries. The first phase would involve changing the 6% add-on to Average Sales Price (ASP) that CMS uses to make drug payments under Part B to 2.5% plus a flat fee (in a budget neutral manner). The second phase would implement value-based purchasing tools similar to those employed by commercial health plans, pharmacy benefit managers, hospitals, and other entities that manage health benefits and drug utilization. Comments are due May 9.

View the proposed rule in the Federal Register.

View the fact sheet.

View the fact sheet for consumers.

View the press release.