Medicare

40-Effect of Beneficiary Agreements Not to Use Medicare Coverage

(Rev. 160, Issued: 10-26-12, Effective: 01-28-13, Implementation: 01-28-13)

(Rev. 194, 09-03-14)

 

On November 13, 2014, the CY 2015 Medicare Physician Fee Schedule (MPFS) final rule was published in the Federal Register. In order to implement corrections to technical errors discovered after publication of the MPFS rule and process claims correctly, Medicare Administrative Contractors will hold claims containing 2015 services paid under the MPFS for the first 14 calendar days of January 2015 (i.e., Thursday January 1 through Wednesday January 14).

December 8, 2014

Medicare requires direct supervision of all hospital outpatient therapeutic services unless CMS makes an assignment of either general or personal supervision for an individual service.

CMS posted a three page list of Hospital Outpatient Therapeutic codes that were evaluated for a change in supervision levels. There is also a hybrid level of supervision for certain services described as non-surgical extended duration therapeutic services (NSEDTS). Refer to CFR 410.27 (a)(1)(iv)(E) for a description of NSEDTS.

All sponsors are required to adopt and implement an effective compliance program, which must include measures to prevent, detect and correct Part C or D program noncompliance as well as FWA.

The compliance program must, at a minimum, include the following core requirements:

 1. Written Policies, Procedures and Standards of Conduct;

 2. Compliance Officer, Compliance Committee and High Level Oversight;

 3. Effective Training and Education;

 4. Effective Lines of Communication;

All persons who provide health or administrative services to Medicare enrollees must satisfy general compliance and FWA

In this MLN Connects™ video on Coding for ICD-10-CM: More of the Basics, Sue Bowman from the American Health

Effective January 1, 2015, OASIS assessment data will be submitted to CMS via the national OASIS Assessment Submission and Processing (ASAP) system. 

With the implementation of the OASIS ASAP system, Home Health Agencies will no longer submit OASIS assessment data to CMS via their state databases. To access the OASIS ASAP system, you will need a QIES / HHA User ID.  

If you currently have a QIES / HHA User ID no action is required. This User ID will allow access to both the OASIS (ASAP) Submission System and CASPER Reporting System.

What are NCDs and LCDs?

NCD — NATIONAL COVERAGE DETERMINATIONS

Medicare specific coverage on the national level. All Medicare carriers are required to follow the NCDs. The NCDs are developed by CMS to describe the circumstances for Medicare coverage nationwide for an item or service. NCDs generally outline the conditions for which an item or service is considered to be covered (or not covered). NCDs are usually issued as a program instruction. Once published in a CMS program instruction, an NCD is binding on all Medicare carriers.

LCD — LOCAL COVERAGE DETERMINATIONS

CMS is aligning the way providers are paid to reward value rather than volume.

Local Medical Review Policies (LMRPs) were converted to LCDs. This was done as a result of the Benefits Improvement and Protection Act of 2000 (BIPA 2000). The difference between LCDs and previously written LMRPs is that LCDs contain only reasonable and necessary conditions of coverage as allowed under section 1862(a)(1)(A) of the Act. LMRPs may have also contained other information such as coding and payment guidelines. Coding and payment information that is not related to section 1862(a)(1)(A) is not contained in an LCD; contractors communicate such information in related articles.

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