This week in Medicare updates–03/30/2016
New waived test
On March 18, CMS released a transmittal to inform 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 12 newly added waived complexity tests. This recurring update notification applies to Chapter 16, Medicare Claims Processing Manual, section 70.8 of the IOM.
Effective Date: July 1, 2016
Implementation date: July 5, 2016
View Transmittal R3479CP.
View MLN Matters article MM9563.
Exit conferences: Sharing specific regulatory references or tags
On March 18, CMS posted a survey and certification letter clarifying guidance to surveyors regarding the procedures for conducting the exit conference in the review of compliance with Medicare or Medicaid Conditions of Participation, Conditions for Coverage, and Requirements for Participation.
View the survey and certification letter.
Rescinded and replaced April 2016 Integrated Outpatient Code Editor (I/OCE)
On March 22, CMS rescinded Transmittal 3477, dated March 11, and replaced it with Transmittal 3483 to revise information in the attachments. The attachments contain the Summary of Modifications and the Summary of Data Changes for April, but it is unclear what was changed from the originally published version. Many changes were made in April to correct errors in the January OCE and the revised transmittal should be reviewed closely.
Effective Date: April 1, 2016
Implementation date: April 4, 2016
View Transmittal R3483CP.
The Medicare contractors for Jurisdiction E overpaid claims for replaced cardiac medical devices when hospitals had not reported manufacturer credits
On March 23, the OIG posted a report stating payments that the Medicare contractors for Jurisdiction E (which covers California, Hawaii, Nevada, and three Pacific territories) made to hospitals for 191 inpatient and outpatient claims for replaced cardiac medical devices did not comply with Medicare requirements for reporting manufacturer credits. The hospitals' incorrect billing of these claims resulted in overpayments of $2.1 million that the hospitals had not identified, refunded, or adjusted by the beginning of the audit. The Medicare contractors overpaid the hospitals because they had no specific controls to ensure that hospitals complied with Medicare requirements for reporting manufacturer credits.
View the report.
Wisconsin Physicians Service's (WPS) payments to providers for hospital outpatient dental services in Jurisdiction 5 and Jurisdiction 8 generally did not comply with Medicare requirements
On March 24, the OIG posted a report stating that WPS’ payments to providers in Jurisdiction 5 (Iowa, Kansas, Missouri, and Nebraska) and Jurisdiction 8 (Indiana and Michigan) for hospital outpatient dental services generally did not comply with Medicare requirements. Of the 100 dental services in the stratified random sample, 95 did not comply with Medicare requirements. Using the sample results, the OIG estimated that WPS improperly paid providers approximately $1.3 million for dental services provided during the period January 1, 2013, through December 31, 2014.
View the report.