This week in Medicare updates
October 2014 update of the hospital outpatient prospective payment System (OPPS)
On August 1, CMS released a Recurring Update Notification describing changes to and billing instructions for various payment policies implemented in the October 2014 OPPS update. Several new codes were included in the update.
Effective date: October 1, 2014
Implementation date: October 6, 2014
View Transmittal R3012CP.
View MLN Matters article MM8873.
Preventing duplicate payments when overlapping inpatient and home health claims are received out of sequence
On August 1, CMS released a change request to improve safeguards to prevent payment of home health services when a beneficiary is an inpatient of a hospital or skilled nursing facility.
Effective date: January 1, 2014
Implementation date: January 5, 2014
View Transmittal R3005CP.
View MLN Matters article MM8699.
Part B rebilling edit corrections and instructions
On August 1, CMS released a change request to modify FISS Part B claims overlap edits related to CMS-1599-F for outpatient Type of Bill (TOB) 13x overlapping TOB 12x. The transmittal also instructs providers that they may offset the Part B co-payment from the Part A deductible or co-payment the patient may have already paid.
Effective date: January 1, 2015
Implementation date: January 5, 2015
View Transmittal R1412OTN.
View MLN Matters article MM8820.
Removal of user-controlled effective date to apply therapy caps to critical access hospital (CAH) claims
On August 1, CMS released a transmittal regarding the application of therapy caps to outpatient therapy services provided in CAHs, which was initially implemented on a time-limited basis. As a result of subsequent rulemaking, this policy is no longer time-limited and is not subject to periodic legislative extensions. This transmittal revised Medicare systems to remove user-controlled effective dates from the process which applies the therapy caps to CAH claims.
Effective date: January 1, 2015
Implementation date: January 5, 2015
View Transmittal R1411OTN.
Inpatient hospital claims and Medicare secondary payer (MSP) claims with Medicare coinsurance days and/or Medicare lifetime reserve days occurring in the seventh or more calendar years
On August 1, CMS released an analysis change request through which it is seeking the assistance of Medicare Shared System Maintainers to analyze and design system specifications that will successfully process inpatient claims with coinsurance and or lifetime reserve days in the seventh or greater years.
Effective date: January 1, 2015
Implementation date: January 5, 2015
View Transmittal R1407OTN.
FY 2015 Inpatient Prospective Payment System (IPPS) final rule
On August 1, 2014, CMS issued a final rule that will update FY 2015 Medicare payment policies and rates under IPPS and the Long-Term Care Hospital Prospective Payment System (LTCH PPS). CMS also posted a press release and two fact sheets giving details on the rule.
View the final rule.
View the CMS IPPS final rule website.
View the press release.
View the overview fact sheet.
View the quality fact sheet.
CMS finalizes updates to the wage index and payment rates for Medicare hospice benefit for FY 2015
On August 4, CMS posted a fact sheet regarding a final rule [CMS-1609-F] to update the Medicare hospice payment rates and the wage index for FY 2015. The final rule reflects the ongoing efforts of CMS to protect beneficiary access to patient-centered hospice care. Hospices will see an estimated 1.4% ($230 million) increase in their payments for FY 2015. The hospice payment increase would be the net result of a hospice payment update to the hospice per diem rates of 2.1% (a “hospital market basket” increase of 2.9% minus 0.8 percentage point for reductions required by law), and a 0.7% decrease in payments to hospices due to updated wage data and the sixth year of CMS’ seven-year phase-out of its wage index budget neutrality adjustment factor.
View the final rule.
View the fact sheet.
PPS and Consolidated Billing for Skilled Nursing Facilities (SNF) for FY 2015
On August 5, CMS posted a final rule in the Federal Register which updates the payment rates used under the PPS for SNFs for FY 2015.
View the notice in the Federal Register.
View related fact sheet.
Inpatient Rehabilitation Facility (IRF) PPS for Federal FY 2015
On August 6, CMS posted a final rule in the Federal Register which updates the prospective payment rates for IRFs for federal FY 2015. This rule finalizes, revises, and delays various policies included in the IRF PPS.
View the notice in the Federal Register.
View related fact sheet.
Inpatient psychiatric facilities (IPF) PPS-update for FY 2015
On August 6, CMS posted a final rule in the Federal Register updating the prospective payment rates for Medicare inpatient hospital services provided by IPFs. These changes will be applicable to IPF discharges occurring during the FY beginning October 1, 2014 through September 30, 2015. This final rule will also address implementation of ICD–10–CM and ICD–10–PCS codes; finalize a new methodology for updating the cost of living adjustments, and finalize new quality measures and reporting requirements under the IPF quality reporting program.
View the notice in the Federal Register.
View the related fact sheet.
Part D beneficiaries with questionable utilization patterns for HIV drugs
On August 6, OIG posted a report detailing Part D beneficiaries with questionable drug utilization patterns.
View the report.
Summer 2014 Hospital Outpatient Payment (HOP) Panel meeting and agenda is now scheduled for one day only
On August 6, CMS announced the summer 2014 HOP Panel meeting and agenda is now scheduled for one day only, Monday, August 25. The public meeting start time is unchanged and it is anticipated the meeting will conclude on Monday no later than approximately 12:00 p.m.
View the story.
Transcatheter Mitral Valve Repair (TMVR)
On August 7, CMS posted a decision memorandum regarding coverage of TMVR. TMVR is covered for the treatment of significant symptomatic degenerative mitral regurgitation when furnished according to an FDA approved indication and multiple conditions are met.
View the decision memorandum.