This week in Medicare updates
Revisions to State Operations Manual (SOM), Appendix PP –“Guidance to Surveyors for Long Term Care Facilities”
On December 12, CMS released an instruction revising the Interpretive Guideline for F309– Quality of Care and F329-Unnecessary Drugs. There are changes to the titles Quality of Care and Unnecessary Drugs
Effective date: December 12, 2014
Implementation date: December 12, 2014
View Transmittal R130SOM.
ICD-10 end-to-end testing frequently asked questions
On December 12, CMS released a special edition MLN Matters article regarding end-to-end testing, during which claims will be processed through all Medicare system edits to produce and return an accurate Electronic Remittance Advice. End-to-end testing is limited to a small sample of submitters who volunteer and are selected for testing.
View special edition MLN Matters article SE1435.
Medicare Benefit Policy Manual, Chapter 13, RHC and FQHC update
On December 12, CMS released a transmittal stating Chapter 13 of the Benefit Policy Manual has been updated to include new information on the Federally Qualified Health Center (FQHC) PPS as required by Section 10501(i)(3)(B) of the Affordable Care Act., and to clarify existing information.
Effective date: January 1, 2015
Implementation date: January 5, 2015
View Transmittal R201BP.
View MLN Matters article MM8981.
Program Integrity Manual,Chapter 12 Revision
On December 12, CMS released a change request to update Program Integrity Manual, Chapter 12 including 1) references to the Exhibits, 2) the number of disputes allowed and 3) the ERRP process.
Effective date: January 1, 2015
Implementation date: January 1, 2015
View Transmittal R560PI.
2015 Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) HCPCS code jurisdiction list
On December 12, CMS released a transmittal with a spreadsheet containing an updated list of the HCPCS codes for DME MAC and Part B local carrier/Part B Medicare Administrative Contractor jurisdictions, which is updated annually to reflect codes that have been added or discontinued (deleted) each year. This Recurring Update Notification applies to Medicare Claims Processing Manual, Chapter 23, section 20.3.
Effective date: January 1, 2015
Implementation date: January 5, 2015
View Transmittal R3148CP.
New waived tests
On December 12, CMS released a change request to inform contractors of new CLIA waived tests approved by the FDA. Since these tests are marketed immediately after approval, CMS must notify its contractors of the new tests so that the contractors can accurately process claims. There are 25 newly added waived complexity tests. The initial release of this Recurring Update Notification applies to Medicare Claims Processing Manual, Chapter 16, section 70.8 of the IOM.
Effective date: January 1, 2015
Implementation date: January 5, 2015
View Transmittal R3149CP.
View MLN Matters article MM8951.
Incorporation of certain provider enrollment policies in CMS-4159-F into Pub. 100-08, Program Integrity Manual (PIM), Chapter 15
On December 12, CMS released a change request to: (a) incorporate into chapter 15 of the PIM certain provider enrollment provisions contained in the final rule titled, "Medicare Program; Contract Year 2015 Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs," and (b) revise various sections of Chapter 15 to address policy issues that have arisen and to make certain technical edits.
Effective date: March 18, 2015
Implementation date: March 18, 2015
View Transmittal R561PI.
Calendar year (CY) 2015 Rural Health Clinic (RHC) and Federally Qualified Health Centers (FQHC) updates
On December 12, CMS released a recurring update notification which provides instructions for CY 2015 payment rate increases for RHCs and FQHCs billing under the AIR and updates to the urban and rural designations for FQHCs billing under the AIR.
Effective date: January 1, 2015
Implementation date: January 5, 2015
View Transmittal R3147CP.
View MLN Matters article MM8980.
January 2015 update of the hospital OPPS
On December 12, CMS released a recurring update notification describing changes to and billing instructions for various payment policies implemented in the January 2015 OPPS update. The January 2015 Integrated Outpatient Code Editor and OPPS Pricer will reflect the HCPCS, APC, HCPCS Modifier, and Revenue Code additions, changes, and deletions identified in this change request. This recurring update notification applies to Medicare Claims Processing Manual, Chapter 4, section 200.9.
Effective date: January 1, 2015
Implementation date: January 5, 2015
View Transmittal R3150CP.
View MLN Matters article MM9014.
Clarification of terms implicating the spousal relationship in regulations and guidance for Medicare- and Medicaid-certified providers and suppliers
On December 12, CMS posted a notice clarifying that the terms “spouse”, “marriage,” “relative,” and “family,” as well as other terms that implicitly or explicitly implicate the spousal relationship, such as (but not limited to) “representative,” “support person,” “surrogate,” and “next-of-kin,” include all marriages lawful where entered into, including lawful same-sex marriages, regardless of the certified provider’s or supplier’s location or the jurisdiction in which the spouse lives. Interpretive Guidance for Appendices A, AA, M, W, PP, and Y: Attached is an advance copy of revisions to the State Operations Manual (SOM), Appendices A, AA, M, PP, W, and Y, incorporating this clarification.
View the survey and certification letter.
Fee for Service Beneficiary Data Streamlining (FFS BDS) updates to operational issues
On December 17, CMS released a change request for the shared system maintainers to perform updates to operational issues from the initial implementation of Phase I of the BDS into the FFS claims processing environment. Transmittal 1429, dated October 1, 2014, is being rescinded and replaced by Transmittal 1448 to update Business Requirement 8677.6 to remove reference to 51/5052 and corrected HICN. All other information remains the same.
Effective date: January 1, 2015
Implementation date: January 5, 2015
View Transmittal R1448OTN.
FY 2015 results for the CMS HAC Reduction Program and Hospital Value-Based Purchasing Program
On December 18, CMS posted a fact sheet stating results for the FY 2015 HAC Reduction Program have been calculated and hospitals have been given a chance to review their preliminary results and request a recalculation of their scores if they believe an error in score calculation has occurred. CMS has also posted Hospital Value-Based Purchasing incentive payment adjustment factors for FY 2015 on the CMS website.
View the fact sheet.
Public reporting of 2013 quality measures on the Physician Compare and Hospital Compare websites
On December 18, CMS posted a fact sheet stating it has added new quality data to the Physician Compare website. Additionally, CMS has updated quality measures on the Hospital Compare website and released data on new measures. These websites are part of an Administration-wide effort to increase the availability and accessibility of information on quality, utilization and costs for effective, informed decision-making.
View the fact sheet.
Final decision for national coverage determinations (NCD) proposed for removal on November 27, 2013
On December 18, CMS posted a final decision regarding removal of NCDs. In August 7, 2013 Federal Register notice (78 FR 48164), CMS established an expedited process for removing NCDs under certain circumstances. The final decision to keep or remove an NCD will be published in a decision memorandum. Removal of an NCD does not necessarily result in noncoverage.
View the final decision.