June Medicare Transmittals and Other Updates

on Monday, 26 June 2017. All News Items | Outpatient Services | OIG | Medicare Coverage | Coding | Billing


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

Summary: Updates the remittance advice remark code (RARC) and claims adjustment reason code (CARC) lists and also instruct ViPS Medicare System (VMS) and Fiscal Intermediary Shared System (FISS) maintainers to update Medicare Remit Easy Print (MREP) and PC Print.

Claim Status Category and Claim Status Codes Update

Summary: Informs MACs about system changes to update, as needed, the Claim Status and Claim Status Category Codes.

July 2017 Update of the Hospital Outpatient Prospective Payment System (OPPS)

  • MLN Matters Number: MM10122
  • Related CR Release Date: May 30, 2017
  • Related CR Transmittal Number: R3783CP
  • Related Change Request (CR) Number: 10122
  • Effective Date: July 1, 2017
  • Implementation Date: July 3, 2017
  • https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM10122.pdf
  • Affects providers and suppliers that submit claims to Medicare Administrative Contractors (MACs), including Home Health and Hospice (HH&H) MACs, for services provided to Medicare beneficiaries and paid under the Outpatient Prospective Payment System (OPPS).

Summary: Describes changes to the OPPS to be implemented in the July 2017 update.

Guidance to Providers that Submit Outpatient Facility Claims and Those That Enter Claims Data via Direct Data Entry (DDE) Screens to Reduce Incidence of Claims Not Crossing Over

  • MLN Matters Number: SE17015
  • Article Release Date: June 6, 2017
  • Related CR Transmittal Number: N/A
  • Related Change Request (CR) Number: 10103
  • Effective Date: August 7, 2017
  • Implementation Date: August 7, 2017
  • https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE17015.pdf
  • Affects institutional provider billers including those who submit HIPAA Accredited Standards Committee (ASC) 837 X12N institutional claims for outpatient hospital facility services to Medicare, and those who submit claims to Medicare via Direct Data Entry (DDE).

Summary: Instructs provider billing offices to correctly submit HIPAA ASC X12N 837 institutional claims to Medicare to reduce the incidence of receiving Return-to-Provider (RTP) edits on incoming 837 outpatient hospital facility claims as well as DDE claims due to edits that will be enforced as of August 7, 2017.

Screening for the Human Immunodeficiency Virus (HIV) Infection

Summary: MACs shall recognize the specified HCPCS codes for services related to the Screening for the Human Immunodeficiency Virus (HIV) Infection.

ICD-10 Coding Revisions to National Coverage Determinations (NCDs)

Summary: A maintenance update of International Classification of Diseases, Tenth Revision (ICD-10) conversions and other coding updates specific to National Coverage Determinations (NCDs). These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received.

“Medicare Benefit Policy Manual” - Chapter 10, Ambulance Locality and Advanced Life Support (ALS) Assessment

Summary: Clarifies the definitions for locality and ground ambulance services for ALS assessment. The term “locality” with respect to ambulance service means the service area surrounding the institution to which individuals normally travel or are expected to travel to receive hospital or skilled nursing services. Your MACs have the discretion to define “locality” in their service areas.

Changes to the Laboratory National Coverage Determination (NCD) Edit Software for October 2017

Summary: The October 2017 quarterly release of the edit module for clinical diagnostic laboratory services.



5 Ways for Healthcare Providers to Get Ready for New Medicare Cards

Summary: Educates providers about steps for removing Social Security numbers from Medicare cards. 

New Medicare Forms

ABN Form

Hospital Discharge Appeal Notices

Advanced Copy- Appendix Z, Emergency Preparedness Final Rule Interpretive Guidelines and Survey Procedures

Summary: The Centers for Medicare & Medicaid Services (CMS) is releasing a new Appendix Z of the State Operations Manual (SOM) which contains the interpretive guidelines and survey procedures for the Emergency Preparedness Final Rule. Appendix Z applies to all 17 providers and suppliers included in the Final Rule.


2017 Compendium of Unimplemented Recommendations

Summary: Identifies significant recommendations to Congress with respect to problems, abuses, or deficiencies for which corrective actions have not been completed. Focuses on the top 25 unimplemented recommendations that, in OIG’s view, would most positively affect HHS programs in terms of cost savings, program effectiveness and efficiency, and quality improvements and should, therefore, be prioritized for implementation.

OIG Spring 2017 Semiannual Report to Congress

Summary: Summarizing activities of the Office of Inspector General (OIG), Department of Health and Human Services (HHS or the Department), for the 6-month period that ended March 31, 2017.

Updates to the OIG Work Plan

Summary: OIG updates this dynamic, web-based Work Plan monthly to ensure that it more closely aligns with the work planning process. The monthly update includes the addition of newly initiated Work Plan items, which can be found on the Recently Added Items page. Also, completed Work Plan items will be removed. Recently published reports can be found on OIG’s What’s New page. This web-based Work Plan will evolve as OIG continues to pursue complete, accurate, and timely public updates regarding our planned, ongoing, and published work.

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