September Medicare Transmittals and Other Updates

on Tuesday, 25 September 2018. All News Items | Outpatient Services | Miscellaneous | Coding | Billing


Healthcare Provider Taxonomy Codes (HPTCs) October 2018 Code Set Update

October 2018 Integrated Outpatient Code Editor (I/OCE) Specifications Version 19.3

October updates to the I/OCE.

Claim Status Category and Claim Status Codes Update

October 2018 Update of the Hospital Outpatient Prospective Payment System (OPPS)

Changes, new codes, and billing instructions for various OPPS payment policies.

Influenza Vaccine Payment Allowances - Annual Update for 2018-2019 Season

Annual Clotting Factor Furnishing Fee Update 2019

Announces the clotting factor furnishing fee for 2019 is $0.220 per unit.

International Classification of Diseases, Tenth Revision (ICD-10) and Other Coding Revisions to National Coverage Determinations (NCDs)

A maintenance update of ICD-10 conversions and other coding updates specific to NCDs.

Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes – October 2018 Update - REVISED

Informs MACs of the October 2018 addition of new HCPCS codes, Q5108 (Injection, fulphila) and Q5110 (Nivestym). The codes are payable by Medicare effective with dates of service on or after July 12, 2018, for Q5108 and effective with dates of service on or after October 1, 2018, for Q5110.



Update to Chapter 15, Pub. 100-08, Certification Statement Policies

Modifications to certain provider enrollment certification statement policies, specifically, allowing upload provider enrollment certification statements using PECOS functionality.

Revisions to the Telehealth Billing Requirements for Distant Site Services – REVISED

Revised to correct the effective date of the GT modifier.

New Waived Tests

New Clinical Laboratory Improvement Amendments of 1988 (CLIA) waived tests approved by the Food and Drug Administration (FDA).



Intensity-Modulated Radiation Therapy (IMRT) Planning Services Editing

When IMRT is paid under the hospital OPPS, hospitals must remember that CPT codes 77014, 77280, 77285, 77290, 77295, 77306 through 77321, 77331, and 77370 are included in the APC payment for CPT code 77301 (IMRT planning). You should not report these codes in addition to CPT code 77301, when provided prior to, or as part of, the development of the IMRT plan. The charges for these services should be included in the charge associated with CPT code 77301, even if the individual services associated with IMRT planning are performed on dates of service other than the date on which CPT code 77301 is reported.



Medicare and Medicaid Programs; Proposed Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction

A proposed rule to relieve burden on healthcare providers by removing unnecessary, obsolete or excessively burdensome Medicare compliance requirements for healthcare facilities.

Provisions in the proposed rule would, for example:

    • Eliminate a duplicative requirement on transplant programs to submit data and other information more than once for “re-approval” by Medicare.
    • Streamline hospital outpatient and ambulatory surgical center requirements for conducting comprehensive medical histories and physical assessments.
    • Allow multi-hospital systems to have unified and integrated Quality Assessment and Performance Improvement programs for all of their member hospitals.
    • Simplify the ordering process for portable x-rays and modernize the personnel requirements for portable x-ray technologists.
    • Remove duplicative ownership disclosure requirements for Critical Access Hospitals.



 Federal Register: Changes to the Low-Volume Hospital Payment Adjustment Under the IPPS

Announces changes to the payment adjustment for low-volume hospitals under the hospital IPPS for acute care hospitals for FY 2011-2017.

Updated Guidance to Hospitals and CAHs Concerning Swing Beds

CMS is providing updated guidance to surveyors for the special requirements for Hospital and CAH providers of long-term care services (LTC), also known as “swing beds”.



 Diabetes Self-Management Training Accrediting Organizations Fact Sheet

CMS Provider Minute Video: The Importance of Proper Documentation — Reminder

Explain importance of proper documentation and how it affects items/services, claim payment, and medical review.

Medicare Fast Facts

Medicare Fast Facts resources this month include:

    • Provider Minute Video: The Importance of Proper Documentation
    • Bill Correctly for Device Replacement Procedures

Medicare Preventive Services On-Line Educational Tool

Information on Medicare preventive services that includes:

    • A link to the National Coverage Determination (NCD) webpage for the service, if it applies
    • HCPCS/Current Procedural Terminology (CPT) codes
    • International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes
    • Coverage requirements
    • Frequency requirements
    • Medicare beneficiary liability

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