This week in Medicare updates–06/08/2016
Payments to home health agencies that do not submit required quality data
On May 27, CMS released two change requests updating instructions for the home health 2% payment reduction process. It also moves those instructions from Pub. 100-04, Medicare Claims Processing Manual, to Pub. 100-22, Medicare Quality Reporting Incentive Programs.
Effective date: August 30, 2016
Implementation date: August 30, 2016
View Transmittal R57QRI.
View Transmittal R3533CP.
View MLN Matters article MM9651.
July 2016 update of the ambulatory surgical center (ASC) payment system
On May 27, CMS released a recurring update notification describing changes to billing instructions for various payment policies implemented in the July 2016 ASC payment system update. This recurring update notification applies to Chapter 14, Medicare Claims Processing Manual, section 10. As appropriate, this notification also includes updates to the HCPCS.
Effective date: July 1, 2016
Implementation date: July 5, 2016
View Transmittal R3531CP.
View MLN Matters article MM9668.
Semiannual Report to Congress
On May 31, the OIG posted the Semiannual Report to Congress. The Inspector General Act of 1978 (Public Law 95-452), as amended, requires that the Inspector General report semiannually to the head of the department and to Congress on the activities of the office during the six-month periods ending March 31 and September 30. The semiannual reports are intended to keep the secretary and the Congress fully and currently informed of significant findings and recommendations by the OIG.
View the report.
Medical review of SNF PPS bills
On May 27, CMS released a change request to update Medicare Program Integrity Manual, Chapter 6.1, Medical Review of Skilled Nursing Facility Prospective Payment System (SNF PPS) bills.
Effective date: June 28, 2016
Implementation date: June 28, 2016
View Transmittal R651PI.
Corrections to revisions to payment policies under the physician fee schedule and other revisions to Part B for CY 2016
On June 1, CMS posted a notice 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.’’ The effective date for the rule was January 1, 2016.
View the notice in the Federal Register.
Corrections and correcting amendment to Electronic Health Record Incentive Program-Stage 3 and Modifications to Meaningful Use in 2015 Through 2017
On June 1, CMS posted a notice in the Federal Register correcting certain technical and typographical errors that appeared in the October 16, 2015 final rule with comment period titled “Medicare and Medicaid Programs; Electronic Health Record Incentive Program—Stage 3 and Modifications to Meaningful Use in 2015 through 2017”. This document is effective on June 1, 2016.
View the notice in the Federal Register.
Updated information on the Intravenous Immune Globulin (IVIG) demonstration
On June 2, CMS posted a special edition MLN Matters article informing providers that a new Medicare contractor, Noridian Healthcare Solutions, LLC, will replace NHIC as the implementation support contractor for the IVIG demonstration as of July 1. This article also reminds suppliers of the 2016 payment rate for demonstration service code Q2052. The 2016 payment rate is $336.05.
View MLN Matters article SE1610.
NCA for gender dysphoria and gender reassignment surgery
On June 2, CMS posted a proposed decision memorandum regarding gender reassignment surgery for Medicare beneficiaries with gender dysphoria.
View the proposed decision memorandum.
Recovery Audit Program contracts update
On June 2, CMS posted an update on the Recovery Audit Program update webpage stating that it is in an active procurement process for the next round of Medicare Fee-for-Service Recovery Audit Program contracts. In anticipation of this contract transition, CMS must ensure that the current Recovery Auditors complete all outstanding claim reviews by the conclusion of the active recovery auditing phase of their current contracts. Providers should note these important dates:
- May 16–The last day that a Recovery Auditor could send Additional Documentation Request letters or semi-automated notification letters.
- July 29–The last day that a Recovery Auditor may send notification of an improper payment to providers including sending a review results letter or no findings letter, and/or providing a portal notification to each provider.
- August 28–Recovery Auditors will complete all discussion periods that are in process by this date. Recovery Auditors continue to be required to hold claims for 30 days, starting with the date of the improper payment notification (via letter or portal) to the provider, to allow for discussion period requests.
- October 1–The last day a Recovery Auditor may send claim adjustment files to the MACs.
View the update.
ESRD for calendar year (CY) 2016
On June 3, CMS released a change request to update the ESRD chapter in the Medicare Benefit Policy Manual to reflect the provisions in the CY 2016 ESRD PPS final rule.
Effective date: January 1, 2016
Implementation date: September 6, 2016
View Transmittal R1671OTN.
Announcement of the Advisory Panel on Clinical Diagnostic Laboratory Tests meeting
On June 3, CMS posted a notice in the Federal Register announcing the next public meeting date of the Advisory Panel on Clinical Diagnostic Laboratory Tests on Monday, July 18. The purpose of the panel is to advise the secretary of HHS and the administrator of CMS of issues related to clinical diagnostic laboratory tests.
View the notice in the Federal Register.
Update report on the National Partnership to Improve Dementia Care in Nursing Homes
On June 3, CMS posted survey and certification letter regarding the second report that provides a brief overview of the National Partnership, summarizes activities following the release of survey and certification policy memorandum 14-19-NH, and outlines next steps. The report describes the results of the Focused Dementia Care Surveys conducted in FY 2015.
View the survey and certification letter.
Public release of Nursing Home Enforcement Information announcement
On June 3, CMS posted a survey and certification letter regarding the information at http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/Survey... which includes data on nursing home enforcement actions between 2006 and 2014. The contents of this letter supports activities or actions to improve patient or resident safety and increase quality and reliability of care for better outcomes.
View the survey and certification letter.