This week in Medicare updates–06/15/2016
Coding revisions to NCDs
On June 3, CMS rescinded Transmittal 1665, dated May 13, and replaced it with Transmittal 1672 to make multiple corrections to procedure and diagnosis codes.
Effective date: October 1, 2016, unless noted differently in requirements
Implementation date: October 3, 2016
View Transmittal R1672OTN.
Temporary pause of QIO short stay reviews
On June 6, CMS posted an update on its Inpatient Hospital Reviews website stating it temporarily paused the Beneficiary and Family Centered Care Quality Improvement Organizations’ (QIO) performance of initial patient status reviews to determine the appropriateness of Part A payment for short stay inpatient hospital claims. CMS took this action in an effort to promote consistent application of the medical review of patient status for short hospital stays. CMS also included a downloadable decision tree called “Policy Decision Guideline—Temporary Suspension of Two-Midnight Reviews” that can be found at the bottom of the same page.
View the update.
Review of CMS' Pioneer Accountable Care Organization Payment Model first performance year administration
On June 7, the OIG posted a report stating it reviewed CMS’ administration of the Pioneer Accountable Care Organization (ACO) Payment Model (Pioneer Model). In general, a Medicare ACO is composed of a group of healthcare providers and suppliers who accept joint responsibility for the cost and quality of Medicare Parts A and B for a specified group of fee-for-service beneficiaries. CMS assigns beneficiaries to each Medicare ACO on an annual basis according to each program's specifications. Through the Pioneer Model, CMS sought to support experienced ACOs in the transformation of its business and care delivery models so that they would not be reliant on fee-for-service volume and could focus on optimizing outcomes of care.
View the report.
FY 2016 HHS OIG Mid-Year Work Plan
On June 7, the OIG posted its FY 2016 Mid-Year Work Plan.
View the report.
Medicare contractors' payments to providers for hospital outpatient dental services in Jurisdictions E and F generally did not comply with Medicare requirements
On June 8, the OIG posted a report stating that payments Medicare contractors made to providers in Jurisdiction E (American Samoa, California, Guam, Hawaii, Nevada, and Northern Mariana Islands) and Jurisdiction F (Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington, and Wyoming) for hospital outpatient dental services generally did not comply with Medicare requirements. Of the 100 dental services in the stratified random sample, 79 did not comply with Medicare requirements. Using its sample results, the OIG estimated that Medicare contractors improperly paid providers in Jurisdictions E and F at least $818,000 from January 1, 2013, through December 31, 2014.
View the report.
JW Modifier: Drug amount discarded/not administered to any patient
On June 9, CMS rescinded Transmittal 3530, dated May 24, and replaced it with Transmittal 3538 to extend the effective and implementation date of the required use of the JW modifier to January 2017.
Effective date: January 1, 2017
Implementation date: January 1, 2017
View Transmittal R3538CP.
Medicare Shared Savings Program; Accountable care organizations (ACO) revised benchmark rebasing methodology, facilitating transition to performance-based risk, and administrative finality of financial calculations
On June 10, CMS posted a final rule in the Federal Register stating that, under the Medicare Shared Savings Program (Shared Savings Program), providers of services and suppliers that participate in ACOs continue to receive traditional Medicare fee-for-service payments under Parts A and B, but the ACO may be eligible to receive a shared savings payment if it meets specified quality and savings requirements. This final rule is effective August 9.
View the final rule in the Federal Register.
View the fact sheet.
View the press release.
Pre-claim review demonstration for home health services
On June 10, CMS posted a notice in the Federal Register announcing a three-year Medicare pre-claim review demonstration for home health services in the states of Illinois, Florida, Texas, Michigan, and Massachusetts, where there have been high incidences of fraud and improper payments for these services. This demonstration will begin in Illinois no earlier than August 1, 2016, in Florida no earlier than October 1, 2016, and in Texas no earlier than December 1, 2016. The demonstration will begin in Michigan and Massachusetts no earlier than January 1, 2017.
View the notice in the Federal Register.
View the fact sheet.