This week in Medicare updates–12/07/2016
Infection Control Pilot: 2017 Update
On November 18, CMS released a Memorandum regarding its three-year pilot project to improve assessment of infection control and prevention regulations in long-term care facilities, hospitals, and during transitions of care. Using draft surveyor Infection Control Worksheets (ICWS) based on the new long-term care regulation as well as a revised hospital surveyor ICWS, 40 hospital surveys will be paired with surveys of long-term care facilities, to provide an opportunity to assess infection prevention during transitions of care. CMS will also pilot technical assistance opportunities for facilities in efforts to improve their infection control programs to meet these new regulations.
OIG Report: Stem Cell Transplantation Implementation Date
On November 22, CMS released MLN Matters SE1624 for providers billing Medicare Administrative Contractors (MAC) for services related to stem cell transplantation. The Office of the Inspector General (OIG) reviewed Medicare claims related to stem cell transplants in a February 2016 report. This Special Edition MLN Matters article addresses issues of incorrect billing and clarifies coverage and billing for stem cell transplantation.
New Physician Specialty Code for Hospitalist
On November 25, CMS released Transmittal 276, which rescinds and replaces Transmittal 274, dated October 28, 2016, to include Screen 9 in the Exhibit of Section 420 of Pub. 100-06. All other information remains the same.
Effective date: April 1, 2017
Implementation date: April 3, 2017
New Revenue Code 0815 for Allogeneic Stem Cell Acquisition Services
On November 25, CMS re-communicated Transmittal 3571 because the transmittal is no longer sensitive. The transmittal number, date of transmittal (July 29, 2016), and all other information remains the same. The transmittal discusses revenue code 0815 (Allogeneic Stem Cell Acquisition Services), which will be accepted into the Fiscal Intermediary Shared System (FISS), effective January 1, 2017 for hospital claims.
Effective date: January 1, 2017
Implementation date: January 3, 2017
Quarterly Update for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program - January 2017
On November 25, CMS released Transmittal 3668, which rescinds and replaces Transmittal 3636, dated October 28, 2016, to provide an explanation regarding a few changes that have occurred in the 2017 HCPCS file.
Effective date: January 1, 2017
Implementation date: January 3, 2017
Implementing Provider File Updates and PECOS to FISS Interface Via Extract File Updates to Accommodate Section 603 Bipartisan Budget Act of 2015
On November 25, CMS re-communicated Transmittal 1704 as the transmittal is no longer sensitive. The transmittal number, date (August 5, 2016), and all other information remains the same.
Effective date: January 1, 2017
Implementation date: January 3, 2017
Semiannual Report to Congress
On November 30, the OIG published its latest Semiannual Report to Congress. The fall edition covers OIG activities from April 2016 through September 2016. In the report, OIG reported expected recoveries of more than $5.66 billion consisting of nearly $1.2 billion in audit receivables and about $4.46 billion in investigative receivables, as well as 844 criminal actions against individuals or entities that engaged in crimes against HHS programs. OIG also reported 708 civil actions, which include false claims and unjust-enrichment lawsuits filed in Federal district court, CMP settlements, and administrative recoveries related to provider self-disclosure matters. The OIG states that its CMP recoveries have increased almost five-fold over the past three years.
New Jersey Doctor Enters Settlement Agreement with OIG on Kickback Allegations
On November 30, the OIG released information on a $111,415 Settlement Agreement with Dr. Robert Collin, a Newark, New Jersey, internist, The settlement resolves allegations that Collin received remuneration from Orange Community MRI, LLC, an imaging facility in Orange, New Jersey, in exchange for patient referrals.
Hospital Appeals Settlement Process Open
On December 1, CMS announced that the 2016 Hospital Appeals Settlement Process is now open. Interested providers should review details and submit an Expression of Interest between December 1, 2016 and January 31, 2017.
Exceptions For Late Hospice Notices of Election Delayed by Medicare Systems
On December 1, CMS published MLN Matters SE1633 for hospices submitting Notices of Election (NOE) to Medicare Administrative Contractors (MAC) for Medicare beneficiaries. Hospices must file a Notice of Election (NOE) for each patient within five calendar days after the effective date of the election. When a hospice’s NOE is not submitted and accepted within that time, Medicare will not cover and pay for days of hospice care from the effective date of election to the date of filing of the accepted NOE. MACs will grant an exception if the hospice is able to provide the MAC with certain required documentation.
Update to Editing of Therapy Services to Reflect Coding Changes
On December 1, CMS published Transmittal 3670, which rescinds and replaces Transmittal 9698, dated October 27, 2016, to replace placeholder codes with the actual codes in the requirements and manual sections and to revise background and policy language. The transmittal instructs contractors to add new CPT codes to report physical and occupational therapy evaluations.
Effective date: January 1, 2017
Implementation date: April 3, 2017
Update to Medicare Deductible, Coinsurance and Premium Rates for 2017
On December 2, CMS published Transmittal 103, which includes instruction for Medicare Contractors to update the claims processing system with the new CY 2017 Medicare rates.
Effective date: January 1, 2017
Implementation date: January 3, 2017
HCPCS Code Update for Preventive Services
On December 2, CMS published Transmittal 3669 regarding the replacement of various HCPCS codes with CPT codes. It also applies the waiver of deductible and coinsurance to CPT code 76706.
Effective date: January 1, 2017
Implementation date: January 3, 2017