Knowledge Base Article
July Medicare Transmittals and Other Updates
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July Medicare Transmittals and Other Updates
Tuesday, July 25, 2017
TRANSMITTALS
The Supplemental Security Income (SSI)/Medicare Beneficiary Data for Fiscal Year 2015 for Inpatient Prospective Payment System (IPPS) Hospitals, Inpatient Rehabilitation Facilities (IRFs), and Long Term Care Hospitals (LTCH)
- MLN Matters Number: MM10026
- Related CR Release Date: June 30, 2017
- Related CR Transmittal Number: R1863OTN
- Related Change Request (CR) Number: CR10026
- Effective Date: July 31, 2017
- Implementation Date: July 31, 2017
- https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM10026.pdf
- Affects providers submitting claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.
Summary: Informs MACs about updated data for determining the disproportionate share adjustment for Inpatient Prospective Payment System (IPPS) hospitals and the low income patient (LIP) adjustment for IRFs as well as payments as applicable for Long Term Care Hospitals (LTCH) discharges (for example, discharges paid the IPPS comparable amount under the short-stay outlier payment adjustment).
Implementing FISS Updates to Accommodate Section 603 Bipartisan Budget Act of 2015 - Phase 2
- MLN Matters®Number: MM9907
- Related Change Request (CR) #: CR 9907
- Related CR Release Date: February 2, 2017
- Effective Date: January 1, 2017
- Related CR Transmittal #: R1783OTN
- Implementation Date: July 3, 2017
- https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM9907.pdf
- Affects Hospital providers who submit claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.
Summary: If a hospital claim is submitted with a service facility location that was not included on the CMS 855A enrollment form, the claim will be Returned to the Provider (RTP) until the CMS 855A enrollment form and claims processing system are updated.
Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure to Procedure (PTP) Edits, Version 23.3, Effective October 1, 2017
- MLN Matters Number: MM10183
- Related CR Release Date: July 14, 2017
- Related CR Transmittal Number: R3807CP
- Related Change Request (CR) Number: CR10183
- Effective Date: October 1, 2017
- Implementation Date: October 2, 2017
- https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM10183.pdf
- Affects physicians, other providers, and suppliers submitting claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.
Summary: Informs the MACs about the update to the National Correct Coding Initiative (NCCI) procedure to procedure edits (PTP). This notice applies to Chapter 23, Section 20.9 of the Medicare Claims Processing Manual
Changes to the Laboratory National Coverage Determination (NCD) Edit Software for October 2017
- MLN Matters Number: MM10156
- Related CR Release Date: June 16, 2017
- Related CR Transmittal Number: R3797CP
- Related Change Request (CR) Number: CR 10156
- Effective Date: October 1, 2017
- Implementation Date: October 2, 2017
- https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM10156.pdf
- Affects physicians, providers and suppliers submitting claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.
Summary: Informs MACs about the changes that will be included in the October 2017 quarterly release of the edit module for clinical diagnostic laboratory services.
Clarifying the Instructions for Amending or Correcting Entries in Medical Records
- CR Release Date: July 21, 2017
- CR Transmittal Number: R732PI
- Change Request (CR) Number: CR 10120
- Effective Date: August 22, 2017
- Implementation Date: August 22, 2017
- https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R732PI.pdf
Summary: Clarifies the requirements for a practitioner to authenticate an alteration or revision in the medical records. The contractor shall also accept initials in instances when the author of the alteration must sign and date a revision made.
Notice of New Interest Rate for Medicare Overpayments and Underpayments -4th Qtr Notification for FY 2017
- CR Release Date: July 13, 2017
- CR Transmittal Number: R291FM
- Change Request (CR) Number: CR 10227
- Effective Date: July 18, 2017
- Implementation Date: July 18, 2017
- https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R291FM.pdf
Summary: Medicare Regulation 42 CFR Section 405.378 provides for the charging and payment of interest on overpayments and underpayments to Medicare providers. The Department of the Treasury has notified the Department of Health and Human Services that the private consumer rate has been changed to 10.125 percent.
REVISED TRANSMITTALS
Qualified Medicare Beneficiary Indicator in the Medicare Fee-For-Service Claims Processing System
- In the article, the CR release date, transmittal number, and the Web address of CR9911 are revised. Clarifications are also made to the second paragraph of the Background section.
- https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9911.pdf
Screening for Hepatitis B Virus (HBV) Infection
- Reflects an updated Change Request (CR) 9859
- https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9859.pdf
Percutaneous Image-guided Lumbar Decompression (PILD) for Lumbar Spinal Stenosis (LSS)
- Transmittals 196 and 3787, dated May 26, 2017, is being rescinded and replaced by Transmittals 199 and 3805 dated, July 11, 2017 to
- https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R199NCD.pdf
- https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3805CP.pdf
Summary: Update references in the CPM and NCD manuals and to add clarifying language. In the NCD manual, the reference to Pub 100-04, Chapter 32, and Section 68 needs to be changed to Section 69. In the CPM manual, the reference in Pub. 100-04, Chapter 32, Section 68 needs to be changed to Section 69 and clarifying language needs to be added to indicate that CMS will cover procedure code 0275T for PILD only when the procedure is performed within any other CED approved randomized and non-blinded clinical trial. All other information remains the same.
OTHER MEDICARE ANNOUNCEMENTS
Proposed Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2018
- July 13, 2017
- https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-07-13-2.html
Summary: The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that includes proposals to update payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2018.
CMS Proposes Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Changes for 2018, and Releases a Request for Information (CMS-1678-P)
- July 13, 2017
- https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-07-13.html
Summary: The Centers for Medicare & Medicaid Services (CMS) issued the Calendar Year (CY) 2018 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System proposed rule (CMS-1678-P) that includes updates to the 2018 rates and quality provisions, and proposes other policy changes. CMS is proposing a number of policies that would support care delivery; reduce burdens for providers, especially in rural areas; lower beneficiary out of pocket drug costs for several drugs; enhance the patient-doctor relationship; and promote flexibility in healthcare.
Revision of Civil Money Penalty (CMP) Policies and CMP Analytic Tool
- July 07, 2017
- Memorandum
Summary: This policy memo replaces S&C Memo 15-16-NH. When noncompliance exists, enforcement remedies, such as civil money penalties (CMPs), are intended to promote a swift return to substantial compliance for a sustained period of time, preventing future noncompliance. To increase national consistency in imposing CMPs, the Centers for Medicare & Medicaid Services (CMS) is revising the CMP analytic tool.
Medicare Quarterly Provider Compliance Newsletter [Volume 7, Issue 4]
Summary: Educational newsletter. This quarter’s focus is on Cert Findings regarding Skilled Nursing Facility (SNF) Certification and Re-certification and OIG Findings regarding Studies of Hospital Billings of use of Modifier 59 on Heart Biopsy Claims and Procedure Coding for Ventilation Support Claims
This material was compiled to share information. MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.
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