This week in Medicare updates
Payments to inpatient rehabilitation facilities (IRF) that do not submit required quality data
On May 8, CMS released a change request stating, for fiscal year (FY) 2014, and each subsequent year, if an IRF agency does not submit required quality data, its payment rates are reduced by 2% for that FY. Application of the 2% reduction may result in an update that is less than 0.0 for an FY and in payment rates for an FY being less than such payment rates for the preceding FY. In addition, reporting-based reductions to the market basket increase factor will not be cumulative; they will only apply for the FY involved.
Effective date: August 11, 2015
Implementation date: August 11, 2015
View Transmittal R44QRI.
View MLN Matters article MM9106.
July 2015 quarterly update for the DME, prosthetics, orthotics and supplies (DMEPOS) competitive bidding program (CBP)
On May 8, CMS released a transmittal with the quarterly updates for the DME CBP files, in order to implement necessary changes to the HCPCS, ZIP code, single payment amount, and supplier files. These requirements provide specific instruction for implementing the DMEPOS CBP files. The recurring update notification applies to Chapter 23, Medicare Claims Processing Manual, section 100.
Effective date: July 1, 2015
Implementation date: July 6, 2015
View Transmittal R3256CP.
View MLN Matters article MM9140.
Updates on hospice election form, revocation, and attending physician
On May 8, CMS rescinded and replaced Transmittal 205, dated April 3, 2015, to revise the effective date of the change and to clarify the types of information that the hospice should use to identify the attending physician or nurse practitioner on the election statement. All other information remains the same. This instruction implements changes finalized in the FY 2015 hospice rule regarding hospice election, revocation, and designation of attending physician.
Effective date: October 1, 2014
Implementation date: May 4, 2015
View Transmittal R209BP.
View MLN Matters article MM9114.
Reasonable cost of therapy and other services furnished by outside suppliers
On May 8, CMS released a change request adding adjusted hourly salary equivalency amount monthly inflation factors for critical access hospitals (CAH) and CAHs with swing beds. These factors are to be applied to physical therapy, respiratory therapy, occupational therapy, and speech-language pathology guideline amounts at the start of a provider’s cost reporting period and to remain in effect for the entire cost reporting period. Factors are listed through September 2016.This change request effects Provider Reimbursement Manual, Part 1, Chapter 14
Effective date: The inflation factors are applied at the beginning of a cost reporting period.
View Transmittal R469PR1.
Correction to the multi-carrier system (MCS) editing on the service location NPI reported for anti-markup and reference laboratory claims
On May 8, CMS released a change request correcting edit 043H that was incorrectly coded under Change Request 8806 (Transmittal 3103, issued November 13, 2014). This change applies to the Medicare Claims Processing Manual.
Effective date: October 1, 2015
Implementation date: October 5, 2015
View Transmittal R3255CP.
View MLN Matters article MM9150.
July 2015 quarterly update HCPCS drug/biological code changes
On May 8, CMS released a transmittal with the updated HCPCS code set for specific drug/biological HCPCS codes. As of July 2015, claims for compounded drugs shall be submitted using the compounded drug, not otherwise classified HCPCS code. This change request is also updating the Section 20.1.2 – Average Sales Price Payment Methodology in Chapter 17 of the Claims Processing Manual 100-04.
Effective date: July 1, 2015
Implementation date: July 6, 2015
View Transmittal R3254CP.
View MLN Matters article MM9167.
Modification to telehealth originating site facility fee billing requirements for rural health clinics (RHC) and federally qualified health centers (FQHC)
On May 8, CMS released a change request to ensure that the telehealth originating site facility fee (HCPCS code Q3014) may be reported separately on RHC and FQHC claims to Medicare.
Effective date: October 1, 2015
Implementation date: October 5, 2015
View Transmittal R1496OTN.
Update of provider enrollment instructions
On May 8, CMS released a change request to update existing provider enrollment instructions in Chapter 15 of Pub. 100-08, Medicare Program Integrity.
Effective date: June 8, 2015
Implementation date: June 8, 2015
View Transmittal R592PI.
Chronic care management (CCM) services frequently asked questions (FAQ)
On May 8, CMS released a MLN Matters special edition article to clarify Medicare’s requirement for 24/7 access by individuals furnishing CCM services to the electronic care plan rather than the entire medical record. Also, CMS released a set of FAQs to address requests received from practitioners and providers for additional guidance in specific areas such as claims submission, intersection with transitional care management services, and the provision of CCM services in facility settings.
View special edition MLN Matters article SE1516.
View the new CCM FAQs.
View the updated CCM fact sheet.
HHA conducted background checks of varying types
On May 13, the OIG posted a report discussing an evaluation done in response to a congressional request to analyze the extent to which HHAs employed individuals with criminal convictions and to explore whether these convictions should have—according to state requirements—disqualified them from HHA employment.
View the report.
Podiatrist admits to defrauding almost $1 million from Medicare
On May 13, the OIG posted a video regarding a podiatrist from Missouri who admitted to defrauding almost $1 million from Medicare.
View the video.