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March 2016 Medicare Updates

Published on 

Tuesday, March 29, 2016

 | Medicare Coverage 

“I don’t know why my brain has kept all the words to the Gilligan’s Island theme song and has deleted everything about triangles.”- Jeff Foxworthy

This month CMS appears to have stuck with their “theme” from past transmittals as a lot of the newly released transmittals are periodic updates of different CMS edits and systems. In contrast, this month, we are broadening our “theme” of bringing you monthly transmittal updates by making this an “all inclusive” Medicare Updates article (i.e., Transmittals, Conditions of Participation, Code of Federal Regulations).

Transmittals

April 2016 Integrated Outpatient Code Editor (I/OCE) Specifications Version 17.1

  • Transmittal 3477, Change Request 9553, MLN Matters MM9553
  • Issued March 22, 2016; Effective: April 1, 2016; Implementation date April 4, 2016
  • Affects providers who submit claims to Medicare Administrative Contractors (MACs), including Home Health and Hospices (HH+H) MACs, for services provided to Medicare beneficiaries
  • Updates Chapter 4, section 40.1; Medicare Claims Processing Manual

Summary of Changes: This notification providers the Integrated OCE instructions and specifications for the Integrated OCE that will be effective April 1, 2016.

Quarterly Update to the Correct Coding Initiative (CCI) Edits, Version 22.2, Effective July 1, 2016

  • Transmittal 3482, Change Request 9516, MLN Matters MM9516
  • Issued March 18, 2016; Effective: July 1, 2016; Implementation date July 5, 2016
  • Affects providers submitting claims to MACs for services provided to Medicare beneficiaries
  • Updates Chapter 23, section 20.9; Medicare Claims Processing Manual

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

April 2016 Update of the Ambulatory Surgical Center (ASC) Payment System

  • Transmittal 3478, Change Request 9557, MLN Matters MM9577
  • Issued March 11, 2016; Effective: April 1, 2016; Implementation date April 4, 2016
  • Affects Ambulatory Surgical Centers (ASCs) who submit claims to MACs
  • Updates Chapter 14, section 10; Medicare Claims Processing Manual

Summary of Changes: This Recurring Update Notification describes changes to billing instructions for various payment policies implemented in the April 2016 ASC payment system update. As appropriate, this notification also includes updates to the Healthcare Common Procedure Coding System (HCPCS).

Telehealth Services

  • Transmittal 221, Change Request 9428, MLN Matters MM9428
  • Issued March 11, 2016; Effective: January 1, 2015; Implementation date April 11, 2016
  • Affects providers submitting claims to MACs for telehealth services provided to Medicare beneficiaries
  • Updates telehealth language has been removed from the Medicare Benefit Policy Manual, Chapter 15, Section 270 and a reference added in text to see the Medicare Claims Processing Manual, Chapter 12, section 190 for further information regarding telehealth services (see related Transmittal 3476)

Summary of Changes: The purpose of this change request is to display the list of telehealth services that were once available through the manual updates to now be displayed via a web-link going forward. CMS is also adding CRNAs to the list of Medicare practitioners who may bill for covered telehealth services.

July Quarterly Update to 2016 Annual Update of HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement

  • Transmittal 3473, Change Request 9561, MLN Matters MM9561
  • Issued March 4, 2016; Effective: January 1, 2016; Implementation date July 5, 2016
  • Affects providers submitting claims to MACs for services provided to Medicare beneficiaries during a SNF stay.
  • Changes to CPT/HCPCS codes and Medicare Physician Fee Schedule designations will be used to revise Common Working File (CWF) edits to allow MACs to make appropriate payments in accordance with policy for SNF consolidated billing in Chapter 6, section 20.6; Medicare Claims Processing Manual

Summary: This notification provides updates to the lists of Healthcare Common Procedure Coding System (HCPCS) codes that are subject to the consolidated billing provision of the SNF Prospective Payment System (PPS).

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

  • Transmittal 3471, Change Request 9549, MLN Matters MM9549
  • Issued February 26, 2016; Effective: April 1, 2016; Implementation date April 4, 2016
  • Affects providers who submit claims to MACs for services provided to Medicare beneficiaries paid under the OPPS.
  • Updates Chapter 4, section 50.8; Medicare Claims Processing Manual

Summary: This Recurring Update Notification describes changes to and billing instructions for various payment policies implemented in the April 2016 OPPS update.

Coding Revisions to National Coverage Determinations

  • Transmittal 1630, Change Request 9540
  • Issued February 26, 2016; Effective: July 1, 2016; Implementation date July 5, 2016

Summary of Changes: This is the 6th maintenance update of ICD-10 conversions and other coding updates specific to national coverage determinations (NCDs). The majority of the NCDs included are a result of feedback received from previous ICD-10 NCD CR7818, CR8109, CR8197, CR8691, CR9087, and CR9252. Some are the result of revisions required to other NCD-related CRs released separately.

Edits to ICD-10 and other coding updates specific to NCDs will be included in subsequent, quarterly releases as needed. No policy-related changes are included with these updates. Any policy-related changes to NCDs continue to be implemented via the current, long-standing NCD process.

Conditions of Participation (CoPs)    

Advance Copy – Interpretive Guidelines for the Organ Transplant CoPs at 42 Code of Federal Regulations (CFR) §§ 482.68 through 482.104

Summary: CMS has updated the Organ Transplant Interpretive Guidelines to incorporate previously-published changes, clarify certain areas, and address feedback received based on previously-released drafts. New Appendix X Interpretive Guidelines supersede all previous versions and will be published in a new Appendix X of the State Operations Manual (SOM).

Article Author: Beth Cobb, RN, BSN, ACM, CCDS
Beth Cobb, RN, BSN, ACM, CCDS, is the Manager of Clinical Analytics at Medical Management Plus, Inc. Beth has over twenty-five years of experience in healthcare including eleven years in Case Management at a large multi-facility health system. In her current position, Beth is a principle writer for MMP’s Wednesday@One weekly e-newsletter, an active member of our HIPAA Compliance Committee, MMP’s Education Department Program Director and co-developer of MMP’s proprietary Compliance Protection Assessment Tool.

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.