Knowledge Base Article
November Medicare Transmittals and Other Updates
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November Medicare Transmittals and Other Updates
Tuesday, November 29, 2016
TRANSMITTALS
New Physician Specialty Code for Hospitalist
- MLN Matters® Number: MM9716
- Related Change Request (CR) #: CR 9716
- Related CR Release Date: October 28, 2016
- Effective Date: April 1, 2017
- Related CR Transmittal #: R3637CP and R274FM
- Implementation Date: April 3, 2017
- Affects physicians, other providers, and suppliers submitting claims to Medicare Administrative Contractors (MACs) for services to Medicare beneficiaries.
- https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9716.pdf
Summary: The Centers for Medicare and Medicaid Services (CMS) has established a new physician specialty code for Hospitalist (C6).
Modifications to the National Coordination of Benefits Agreement Crossover Process
- MLN Matters® Number: MM9681
- Related Change Request (CR) #: CR 9681
- Related CR Release Date: October 27, 2016
- Effective Date: April 1, 2017
- Related CR Transmittal #: R1733OTN
- Implementation Date: April 3, 2017
- Affects providers, including hospices, submitting institutional claims to Medicare Administrative Contractors (MACs) requiring Coordination of Benefits (COB) for services provided to Medicare beneficiaries.
- https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9681.pdf
Summary: Modifies the Part A shared system to ensure that all 837 institutional Coordination of Benefits (COB) claims will contain a Claim Adjustment Reason Code and Remittance Advice Remark Code combination, that hospital day counts may not be entered duplicatively on incoming claims submissions to Medicare, and that Present on Admission (POA) indicators are only permitted on incoming inpatient hospital-oriented claims.
Instructions to Process Services Not Authorized by the Veterans Administration (VA) in a Non-VA Facility Reported with Value Code (VC) 42
- MLN Matters® Number: MM9818
- Related Change Request (CR) #: CR 9818
- Related CR Release Date: October 28, 2016
- Effective Date: October 1, 2013
- Related CR Transmittal #: R3635CP
- Implementation Date: April 3, 2017
- Affects hospitals and skilled nursing facilities who submit inpatient claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.
- https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9818.pdf
Summary: Clarifies how Medicare contractors shall process inpatient claims for services in a Non-VA facility that were not authorized by the VA.
Issuing Compliance Letters to Specific Providers and Suppliers Regarding Inappropriate Billing of Qualified Medicare Beneficiaries (QMBs) for Medicare Cost-Sharing
- MLN Matters®Number: MM9817
- Related Change Request (CR) #: CR 9817
- Related CR Release Date: November 4, 2016
- Effective Date: December 6, 2016
- Related CR Transmittal #: R1747OTN
- Implementation Date: March 8, 2017
- Affects providers submitting claims to Medicare Administrative Contractors (MACs) and Durable Medical Equipment MACs (DME MACs) for services provided to certain Medicare beneficiaries.
- https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9817.pdf
Summary: Federal law bars Medicare providers from charging individuals enrolled in the Qualified Medicare Beneficiary Program (QMB) for Medicare Part A and B deductibles, coinsurances, or copays. Change Request (CR) 9817 instructs MACs to issue a compliance letter instructing named providers and suppliers to refund any erroneous charges and recall any past or existing billing with regard to improper QMB billing.
Therapy Cap Values for Calendar Year (CY) 2017
- MLN Matters® Number: MM9865
- Related Change Request (CR) #: CR 9865
- Related CR Release Date: November 4, 2016
- Effective Date: January 1, 2017
- Related CR Transmittal #: R3644CP
- Implementation Date: January 3, 2017
- Affects physicians, therapists, and other providers submitting claims to Medicare Administrative Contractors (MACs), including Home Health & Hospice MACs, for outpatient therapy services provided to Medicare beneficiaries.
- https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9865.pdf
Summary: Describes the amounts and policies for outpatient therapy caps for CY 2017. For physical therapy and speech-language pathology combined, the 2017 therapy cap will be $1,980. For occupational therapy, the cap for 2017 will be $1,980.
Quarterly Update to the Correct Coding Initiative (CCI) Edits, Version 23.0, Effective January 1, 2017
- MLN Matters®Number: MM9847
- Related Change Request (CR) #: CR 9847
- Related CR Release Date: November 4, 2016
- Effective Date: January 1, 2017
- Related CR Transmittal #: R3646CP
- Implementation Date: January 3, 2017
- Affects physicians, providers, and suppliers submitting claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.
- https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9847.pdf
Summary: Instructs MACs of the normal update to the Correct Coding Initiative (CCI) Procedure to Procedure (PTP) edits, effective January 1, 2017.
Payment Reduction for X-Rays Taken Using Film
- MLN Matters®Number: MM9727
- Related Change Request (CR) #: CR 9727
- Related CR Release Date: August 12, 2016
- Effective Date: January 1, 2017
- Related CR Transmittal #: R3583CP
- Implementation Date: January 3, 2017
- Affects physicians, other providers, and suppliers who submit Part B claims to Medicare Administrative Contractors (MACs) for X-ray imaging services provided to Medicare beneficiaries.
- https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9727.pdf
Summary: Reduces the technical component (TC) (including the TC portion of a global service) of X-ray imaging services provided using film.
2017 Annual Update to the Therapy Code List
- MLN Matters®Number: MM9782
- Related Change Request (CR) #: CR 9782
- Related CR Release Date: November 10, 2016
- Effective Date: January 1, 2017
- Related CR Transmittal #: R3654CP
- Implementation: January 3, 2017
- Affects physicians, therapists, and other providers, including Comprehensive Outpatient Rehabilitation Facilities (CORFs), submitting claims to Medicare Administrative Contractors (MACs), including Home Health & Hospice MACs, for outpatient therapy services provided to Medicare beneficiaries.
- https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9782.pdf
Summary: Updates the therapy code list for Calendar Year (CY) 2017 by adding eight “always therapy” codes (97161 – 97168) for physical therapy (PT) and occupational therapy (OT) evaluative procedures and deletes the four codes currently used to report these services (97001 – 97004).
ICD-10 Coding Revisions to National Coverage Determination (NCDs)
- Transmittal 1755
- Date: November 18, 2016
- Change Request 9861
- https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R1755OTN.pdf
Summary: The 10th maintenance update of 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.
Annual Update of HCPCS Codes Used for Home Health Consolidated Billing Enforcement
- MLN Matters®Number: MM9771
- Related Change Request (CR) #: CR 9771
- Related CR Release Date: October 7, 2016
- Effective Date: January 1, 2017
- Related CR Transmittal #: R3618CP
- Implementation Date: January 3, 2017
- Affects Home Health Agencies (HHAs) and other providers submitting claims to Medicare Administrative Contractors (MACs) for services to Medicare beneficiaries in a home health period of coverage.
- https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9771.pdf
Summary: 2017 annual update to the list of HCPCS codes used by Medicare systems to enforce consolidated billing of home health services.
Office of Inspector General Report: Stem Cell Transplantation
- MLN Matters®Number: SE1624
- Article Release Date: November 22, 2016
- Affects providers billing Medicare Administrative Contractors (MACs) for services related to stem cell transplantation.
- https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1624.pdf
Summary: Addresses issues of incorrect billing as a result of the February 2016 OIG report and clarifies coverage of stem cell transplantation.
MEDICARE HOSPITAL PAYMENT RULES
Hospital Inpatient Prospective System (IPPS) Final Rule Correction Notice
- October 31, 2016
- https://www.gpo.gov/fdsys/pkg/FR-2016-10-31/pdf/2016-26182.pdf
Summary: This document corrects a typographical error in the final rule that appeared in the August 22, 2016 Federal Register as well as additional typographical errors in a related correction to that rule that appeared in the October 5, 2016 Federal Register.
Hospital Outpatient Prospective System (OPPS) and ASC Final Rule
- November 1, 2016
- http://tinyurl.com/gvm4vor
Summary: This final rule with comment period revises 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 CMS’s continuing experience with these systems.
OTHER MEDICARE ANNOUNCEMENTS
2017 Medicare Parts A & B Premiums and Deductibles Announced
- November 10, 2016
- https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2016-Press-releases-items/2016-11-10-2.html
Summary: The 2017 premiums for the Medicare inpatient hospital (Part A) and physician and outpatient hospital services (Part B) programs.
New Recovery Auditor Contracts Awarded
- October 31, 2016 – CMS has awarded the next round of Medicare Fee-for-Service Recovery Audit Contractor (RAC) contracts to:
- Region 1 – Performant Recovery, Inc.
- Region 2 – Cotiviti, LLC
- Region 3 – Cotiviti, LLC
- Region 4 – HMS Federal Solutions
- Region 5 – Performant Recovery, Inc
- RAC Recent Updates webpage
The RACs in Regions 1-4 will perform postpayment review to identify and correct Medicare claims that contain improper payments (overpayments or underpayments) that were made under Part A and Part B, for all provider types other than Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) and Home Health/Hospice. The Region 5 RAC will be dedicated to the postpayment review of DMEPOS and Home Health/Hospice claims nationally.
CMS Hospital Value-Based Purchasing Program Results for Fiscal Year 2017
- November 1, 2016
- Adjustments to Medicare hospital payments based on the quality of care they provide to patients as determined by quality reporting
- 2017 VBP Fact Sheet
- Includes link to FY2017 Hospital VBP incentive payment adjustment factors
Fiscal Year 2017 HHS OIG Work Plan
- November 10, 2016
- https://oig.hhs.gov/reports-and-publications/workplan/index.asp
Summary: The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) Work Plan for fiscal year (FY) 2017 summarizes new and ongoing reviews and activities that OIG plans to pursue with respect to HHS programs and operations during the current fiscal year and beyond.
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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