Medicare

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.

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that a Virtual Office Hours session regarding Getting Started with Quality Measures has been scheduled for Monday, November 17, 2014 from 3:00–4:00 PM ET

This session will allow stakeholders an opportunity to ask a CMS representative questions about getting started with reporting and submitting prospective quality measures for the PQRS program.

Recovery Audit Contractors, also known as RAC, is a program that seeks to identify and correct improper payments for services provided to Medicare Parts A & B beneficiaries. This includes both recoupment of overpayments and corrected distribution of underpayments made by CMS.  

The following chart identifies each of the 7 zones for ZPIC and the states/regions within each zone. Links are provided for each zone which contains information about each zone as well as activity and updates in those regions. 

Medicare understands that there are individuals who may not meet the diagnostic criteria for substance abuse, but who are still at risk. To help identify these individuals and take steps to keep them from reaching the level of abuse, Medicare has established a program called the Screening, Brief Intervention, and Referral to Treatment (SBIRT) Services.

Anyone who uses modifier 59 needs to be aware that due to problems with the incorrect usage of this modifier (which by the way is also revised for 2015,) CMS has added four new HCPCS modifiers. An announcement by CMS stated that "CMS is establishing four new HCPCS modifiers to define subsets of the -59 modifier, a modifier used to define a “Distinct Procedural Service.” 

These new codes are:

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