This week in Medicare updates
Inpatient hospital claims and Medicare Secondary Payer (MSP) claims with Medicare Coinsurance Days and/or Medicare Lifetime Reserve Days occurring in the 7th-15th years
On June 4, CMS released a change request to rescind Transmittal 108 and replace it with Transmittal 112 to incorporate changes from CR 8947, which was erroneously overwritten. It revises Medicare systems to accurately process inpatient hospital claims and MSP claims with coinsurance and/or lifetime reserve days in the 7th to 15th years. All other information remains the same.
Effective date: April 1, 2015
Implementation date: April 6, 2015
View Transmittal R112MSP.
July 2015 update of the hospital OPPS
On June 5, CMS released the recurring update notification describing changes to and billing instructions for various payment policies implemented in the July 2015 OPPS update. The July 2015 Integrated Outpatient Code Editor (I/OCE) and OPPS Pricer will reflect the HCPCS, APC, HCPCS Modifier, and Revenue Code additions, changes, and deletions identified in this change request. It applies to Chapter 4, Medicare Claims Processing Manual, section 20.6.11.
Effective date: July 1, 2015
Implementation date: July 6, 2015
View Transmittal R3280CP.
View MLN Matters article MM9205.
Supplemental Security Income (SSI)/Medicare beneficiary data for FY 2013 for IPPS hospitals, inpatient rehabilitation facilities (IRF), and long term care hospitals (LTCH)
On June 5, CMS released instructions to provide updated data for determining the disproportionate share adjustment for IPPS hospitals and the low-income patient adjustment for IRFs and for LTCH discharges (e.g., discharges paid the IPPS comparable amount under the short-stay outlier payment adjustment). The SSI/Medicare beneficiary data for hospitals are available electronically and contains the name of the hospital, CMS certification number, SSI days, total Medicare days, and the ratio of Medicare Part A patient days attributable to SSI recipients.
Effective date: July 6, 2015
Implementation date: July 6, 2015
View Transmittal R1508OTN.
View MLN Matters article MM9195.
IPPS hospital extensions per the Medicare Access and CHIP Reauthorization Act of 2015
On June 5, CMS rescinded Transmittal 3263, dated May 22, 2015, and replaced it with Transmittal 3281 to correct the extension through date of the Medicare Dependent Hospital (MDH) program and provides information and implementation instructions for Sections 204 and 205 of the Medicare Access and CHIP Reauthorization Act of 2015. All other information remains the same.
Effective date: April 1, 2015
Implementation date: July 6, 2015
View Transmittal R3281CP.
July 2015 update of the ASC payment system
On June 5, CMS released a recurring update notification describes changes to billing instructions for various payment policies implemented in the July 2015 ASC payment system update. This recurring update notification applies to Chapter 14, Medicare Claims Processing Manual, section 10.
Effective date: July 1, 2015
Implementation date: July 6, 2015
View Transmittal R3279CP.
View MLN Matters article MM9207.
Information and resources for submitting correct ICD-10 codes to Medicare
On June 8, CMS released a special edition MLN Matters article aimed toward all physicians, providers, and suppliers who submit claims to MACs, including home health & hospice and DME MACs, for services provided to Medicare beneficiaries. It includes links and resources intended to assist in submitting correct ICD-10 codes to Medicare.
View special edition MLN Matters article SE1518.
Using the ICD-10-PCS New Technology Section X codes
On June 9, CMS released a special edition MLN Matters article intended to assist hospital providers by offering details about the new ICD-10-PCS Section X New Technology, as well as specific coding instruction for the new section.
View special edition MLN Matters article SE1519.
Medicare Shared Savings Program: Accountable Care Organizations (ACO)
On June 9, CMS posted a final rule in the Federal Register addressing changes to the Medicare Shared Savings Program including provisions relating to the payment of ACOs participating in the Medicare Shared Savings Program. Providers and suppliers that participate in an ACO continue to receive traditional Medicare fee-for-service payments under Parts A and B and may be eligible to receive a shared savings payment if it meets specified quality and savings requirements. With the exception of the amendments to §§ 425.312, 425.704, and 425.708, the provisions of this final rule are effective on August 3, 2015.
View the notice in the Federal Register.
Fraud Alert: Physician compensation arrangements may result in significant liability
On June 9, the OIG posted a fraud alert stating physicians who enter into compensation arrangements such as medical directorships must ensure that those arrangements reflect fair market value for bona fide services the physicians actually provide.
View the fraud alert.
Medicare and Medicaid 50th anniversary countdown
On June 10, CMS posted a press release announcing the 50th anniversary of the enactment of Amendments to the Social Security Act that established the Medicare and Medicaid programs. Over the next 50 days, CMS will recognize the impact these two programs have had in transforming our nation’s healthcare system.
View the press release.
Hospital Appeals Settlement update
On June 11, CMS stated on its Inpatient Hospital website that, as of June 1, it has executed settlements with more than 1,900 hospitals, representing approximately 300,000 claims. CMS has paid approximately $1.3 billion to providers.
View the website.
Proof and date of delivery
On June 12, CMS released a change request to provide DME MACs instructions regarding who can fill out the date of delivery on the proof of delivery.
Effective date: July 13, 2015
Implementation date: July 13, 2015
View Transmittal R598PI.
Award of MAC contract for Jurisdiction M
On June 12, CMS released a change request to announce the award of the A/B MAC Jurisdiction M contract to Palmetto GBA for the administration of Medicare Part A and Part B Fee-for-Service claims as well as the Home Health & Hospice Region C service area.
Effective date: April 1, 2015
Implementation date: July 13, 2015
View Transmittal R1510OTN.