Knowledge Base Article

TRANSMITTALS

Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print Update

• Transmittal 3562, Change Request 9695, MLN Matters Article MM9695
• Issued July15, 2016, Effective October 1, 2016, Implementation October 3, 2016
• Affects physicians, providers, and suppliers submitting claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.

Summary of Changes: The purpose of this Change Request (CR) is to update the Remittance Advice Remark Code (RARC) and Claim Adjustment Reason Code (CARC) lists and also to instruct ViPS Medicare System (VMS) and Fiscal Intermediary Shared System (FISS) to update Medicare Remit Easy Print (MREP) and PC Print.

The Supplemental Security Income (SSI)/Medicare Beneficiary Data for Fiscal Year 2014 for Inpatient Prospective Payment System (IPPS) Hospitals, Inpatient Rehabilitation Facilities (IRFs), and Long Term Care Hospitals (LTCH)

• Transmittal 1681, Change Request 9648, MLN Matters Article MM9648
• Issued July 15, 2016, Effective August 16, 2016, Implementation August 16, 2016
• Affects Inpatient Prospective Payment System (IPPS) hospitals, Inpatient Rehabilitation Facilities (IRFs), and Long Term Care Hospitals (LTCHs) submitting
• claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.

Summary of Changes: Provides updated data for determining the disproportionate share adjustment for IPPS hospitals and the Low Income Patient (LIP) adjustment for IRFs as well as payments as applicable for LTCH discharges

Quarterly Update to the Correct Coding Initiative (CCI) Edits, Version 22.3, Effective October 1, 2016

• Transmittal 3561, Change Request 9725, MLN Matters Article MM9725
• Issued July 15, 2016, Effective October 1, 2016, Implementation October 3, 2016
• Affects physicians, providers, and suppliers submitting claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.

Summary of Changes: This is the normal update to the CCI procedure to procedure edits.

July 2016 Update of the Hospital Outpatient Prospective Payment System (OPPS)

• Transmittal 3552 and 3557, Change Request 9658, MLN Matters Article MM9658
• Issued June 28 and July 1, 2016, Effective July 1, 2016, Implementation July 5, 2016
• Affects providers and suppliers who submit claims to Medicare Administrative Contractors (MACs), including Home Health and Hospice (HH&H) MACs, for services provided to Medicare beneficiaries and which are paid under the Outpatient Prospective Payment System (OPPS).

Summary of Changes: This Recurring Update Notification describes changes to and billing instructions for various payment policies implemented in the July 2016 OPPS update. Transmittal 3557 replaces Transmittal 3552 to include the statement announcing delay in implementation of the reporting for certain outpatient department services (that are similar to therapy services) (“non-therapy outpatient department services”) that are adjunctive to comprehensive APC procedures.

Medicare Coverage of Diagnostic Testing for Zika Virus

• MLN Matters Article SE1615
• Issued June 27, 2016
• Affects physicians, providers, and clinical diagnostic laboratories who submit claims to Medicare Administrative Contractors (MACs) for services to Medicare beneficiaries.

Summary of Changes: This MLN Matters Special Edition Article informs the public that Medicare covers Zika virus testing under Medicare Part B as long as the clinical diagnostic laboratory test is reasonable and necessary for the diagnosis or treatment of a person’s illness or injury. This article reminds laboratories furnishing Zika virus tests to contact their MACs for guidance on the appropriate billing codes to use on claims for Zika virus testing. Furthermore, laboratories should provide resources and cost information as may be requested by the MACs in order for the MACs to establish appropriate payment amounts for the tests.

Notice of New Interest Rate for Medicare Overpayments and Underpayments -4th Qtr Notification for FY 2016

• Transmittal 270, Change Request 9750
• Issued July 12, 2016, Effective July 18, 2016, Implementation July 18, 2016

Summary of Changes: Recurring notification of interest rates.

OTHER UPDATES

CMS Proposes Hospital Outpatient Prospective Payment System Changes to Better Support Physicians and Improve Patient Care

• 2017 OPPS Proposed Rule CMS-1656-P
• Issued July 6, 2016

Summary of Changes: This proposed rule would revise the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2017 to implement applicable statutory requirements and changes arising from our continuing experience with these systems.

Medicare Quarterly Compliance Newsletter

• July 2016 Edition

Summary: Articles on Automatic External Defibrillators, Treprostinil Inhalation Solution, Therapeutic Shoes for Persons with Diabetes, and Hospital Outpatient Dental Services.