This week in Medicare updates
Claims that are related
On September 12, CMS released a 4th version of a transmittal allowing the MACs and Zone Program Integrity Contractors the discretion to deny claims that are "related" and providing approved examples of such situations. Rescinded versions of the transmittal include R534PI, R537PI, and R540PI. Note: R534PI is not currently marked as rescinded even though R540PI indicates it is a replacement and R537PI is not posted separately but is currently posted as the attachment to R534PI.
Effective date: September 8, 2014
Implementation date: September 8, 2014
View Transmittal R541PI.
FY 2015 IPPS and long term care hospital (LTCH) PPS changes
On September 12, CMS released a recurring change request providing the FY 2015 update to the IPPS and LTCH PPS. This Recurring Update Notification applies to Medicare Claims Processing Manual, Chapter 3, section 20.2.3.1.
Effective date: October 1, 2014
Implementation date: October 6, 2014
View Transmittal R3066CP.
View MLN Matters article MM8900.
Billing for cost based payment for certified registered nurse anesthetists (CRNA) services furnished by OPPS hospitals
On September 12, CMS released a change request to manualize system logic changes previously implemented.
Effective date: April 1, 2003
Implementation date: December 15, 2014
View Transmittal R3065CP.
View MLN Matters article MM8897.
Medicare Part B prescription drug dispensing and supplying fee payment rates are considerably higher than the rates paid by other government programs
On September 16, OIG posted a report stating Medicare Part B would have saved millions of dollars in 2011 if dispensing fees for inhalation drugs administered through durable medical equipment and supplying fees for immunosuppressive drugs associated with an organ transplant, oral anticancer chemotherapeutic drugs, and oral antiemetic drugs used as part of an anticancer chemotherapeutic regimen had been aligned with the rates that Part D and State Medicaid programs paid. Part B paid $132.9 million in dispensing and supplying fees. It is estimated if Part B rates had been the same as the average Part D rates, Part B would have paid dispensing and supplying fees of $22 million, a savings of $110.9 million, and if Part B rates had been the same as the average State Medicaid program rates, Part B would have paid dispensing and supplying fees of $26.6 million, a savings of $106.3 million.
View the report.
Medicare ACOs continue to succeed in improving care, lowering cost growth
On September 16, CMS issued quality and financial performance results showing that Medicare Accountable Care Organizations (ACOs) have successfully improved the quality of care for Medicare beneficiaries by fostering greater collaboration between doctors, hospitals, and health care providers and keeping patients healthy rather than treating them when they were sick.
View the fact sheet.
New waived tests
On September 17, CMS rescinded and replaced a transmittal on new CLIA waived tests to correct coding information for one test.
Effective date: October 1, 2014
Implementation date: October 6, 2014
View Transmittal R3070CP.
Minor updates to hospital appeals settlement
On September 17, CMS posted small changes to its offer to pay 68% for pending appeal claims to hospitals that withdraw their pending appeals. Updates included small language changes, including a REVISED Administrative Agreement which resolved an issue with the fillable hospital name field being too short for some hospital names.
View the website.
Read the transcript or listen to the audio of the MLN Matters call regarding this settlement.
Medicare Advantage enrollment at all-time high; premiums remain affordable
On September 18, a press release from CMS announced that more people with Medicare will have access to higher quality Medicare Advantage plans, and for the fifth straight year, enrollment is projected to increase to a new all-time high, while premiums remain affordable.
View the press release.
CMS uploads document from August 2014 meeting of Advisory Panel on Hospital Outpatient Payment
CMS uploaded a document detailing the events of the Advisory Panel on Hospital Outpatient Payment meeting that took place in August 2014, including agenda and recommendations. They did not however, publish information on the recommendations related to supervision of chemotherapy and complex drugs or biologic agents administration. Supervision of these services was on the agenda for the meeting and CMS had solicited comments prior to the meeting.
View the Advisory Panel on Hospital Outpatient Payment website.
Revised guidance related to new & revised hospital governing body and medical staff regulations
On September 19, CMS has updated its Hospital interpretive guidelines in State Operations Manual Appendix A to reflect recent amendments to the Governing Body and Medical Staff Conditions of Participation, as well as to make technical corrections, and clarify and update selected portions of the guidance. The revised regulations were effective July 11, 2014.
View the survey and certification letter.