This week in Medicare updates
Influenza vaccine payment allowance update
On September 3, CMS released a recurring update notification regarding payment allowances for the seasonal influenza virus vaccines as updated on an annual basis effective August 1 of each year. The attached recurring update applies to Pub. 100-04, Medicare Claims Processing, Chapter 17, section 20.5.9.
Effective date: August 1, 2014
Implementation date: No later than November 24, 2014
View Transmittal R3059CP.
View MLN Matters article MM8890.
Claims that are related
On September 4, CMS released a change request in order to allow the MACs and Zone Program Integrity Contractors the discretion to deny claims that are "related" and provide approved examples of such situations. Transmittal 534, dated August 8, 2014, is being rescinded and replaced by Transmittal 540 to adhere to CMS Inpatient recoding policy standards, which was accomplished by removing the recoding language in section 3.2.3 in the Manual Instructions. All other information remains the same.
Effective date: September 8, 2014
Implementation date: September 8, 2014
View Transmittal R540PI.
Screening for Hepatitis C virus (HCV) in adults
On September 5, CMS released a transmittal effective for services performed on or after June 2, 2014, stating it will cover screening for hepatitis C virus consistent with the grade B recommendations by the USPSTF for the prevention or early detection of an illness or disability and is appropriate for individuals entitled to benefits under Medicare Part A or enrolled under Part B.
CMS then released a second transmittal stating this revision to the Medicare National Coverage Determinations Manual is a national coverage determination (NCD). NCDs are binding on all carriers, fiscal intermediaries, contractors with the Federal government that review and/or adjudicate claims, determinations, and/or decisions, quality improvement organizations, qualified independent contractors, the Medicare appeals council, and ALJs (see 42 CFR section 405.1060(a)(4) (2005)). An NCD that expands coverage is also binding on a Medicare advantage organization. In addition, an ALJ may not review an NCD.
Effective date: June 2, 2014,
Implementation date: January 5, 2015, for non-shared MAC edits and CWF analysis; April 6, 2015, for remaining shared systems edits
View Transmittal R3063CP.
View Transmittal R174NCD.
Examining the difference between a National Provider Identifier (NPI) and a Provider Transaction Access Number (PTAN)
On September 5, CMS posted a special edition MLN Matters article explaining the difference between a NPI and a PTAN. There are no policy changes in this article.
View MLN Matters article SE1216.
2014-2015 influenza resources for health care professionals
On September 9, CMS released a special edition MLN Matters article reminding health care professionals that Medicare Part B reimburses health care providers for flu vaccines and their administration. Medicare provides coverage of the flu vaccine without any out-of-pocket costs to the Medicare patient. No deductible or copayment/coinsurance applies.
View special edition MLN Matters article SE1431.
Updated information regarding CMS offer to hospitals to withdraw pending appeals for partial payment
On September 9, CMS updated its report regarding its offer for certain hospitals to withdraw pending appeals in exchange for timely partial payments. People can now listen to a recording teleconference on this topic, and review an updated Frequently Asked Question document and an updated eligible claim spreadsheet.
View the updates.
Access the recording and Frequently Asked Questions.
October update to the CY 2014 MPFSDB
On September 10, CMS released a change request stating payment files were issued to contractors based upon the CY 2014 Medicare Physician Fee Schedule (MPFS) final rule. This change request amends those payment files. This Recurring Update Notification applies to Pub. 100-04, Medicare Claims Processing Manual, Chapter 23, section 30.1. Transmittal 3046, dated August 22, 2014, is being rescinded and replaced by Transmittal 3064 to correct the mainframe file names listed here and in the change request’s attachment and Procedure Status for HCPCS code 0275T is corrected to "R". All other information remains the same.
Effective date: October 1, 2014,
Implementation date: October 6, 2014
View Transmittal R3064CP.
View MLN Matters article MM8888.
CMS has yet to enforce a statutory provision related to rural health clinics
On September 12, OIG posted a report regarding its finding stating that approximately 12% of RHCs no longer met the location requirements in 2013. Pursuant to the BBA, these RHCs should continue to qualify as RHCs—and receive enhanced reimbursement—only if they are determined to be essential providers. However, CMS has yet to issue final regulations that would allow RHCs that do not meet the location requirements to qualify as essential-provider RHCs.
View the report.