Changes in Bypass Payment Edits (3-days and 1-day) For Donor Post-Kidney Transplant

Changes in Bypass Payment Edits (3-days and 1-day) For Donor Post-Kidney Transplant

The MACs to implement logic that ensures they bypass payment window edits (3-days and 1-day) when processing claims for donor post-kidney transplant complications services. MACs will hold certain claims, as noted below, until Medicare’s Common Working File (CWF) system edits these claims correctly. 3-Day Payment Window Edits: 7109: Outpatient Diagnostic Service against Inpatient in history…

Holding of 2016 date-of-service claims for services paid under the Medicare physician fee schedule

Holding of 2016 date-of-service claims for services paid under the Medicare physician fee schedule

On October 30, 2015, the calendar year (CY) 2016 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 2016 services paid under the MPFS for…

Decision Memo for Transcatheter Mitral Valve Repair (TMVR)

Decision Memo for Transcatheter Mitral Valve Repair (TMVR)

The Centers for Medicare & Medicaid Services (CMS) covers transcatheter mitral valve repair (TMVR) under Coverage with Evidence Development (CED) with the following conditions:  TMVR is covered for the treatment of significant symptomatic degenerative mitral regurgitation when furnished according to an FDA approved indication and when all of the following conditions are met. 1. The…

CMS Announces Intent to Engage in Rulemaking for EHR Incentive Program Changes

CMS Announces Intent to Engage in Rulemaking for EHR Incentive Program Changes

The Centers for Medicare & Medicaid Services (CMS) intends to engage in rulemaking this spring to help ensure providers continue to meet meaningful use requirements.In response to input from health care providers and other stakeholders, CMS is considering the following changes to the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs: Shortening the 2015…

Sequestration mandatory payment reduction of two percent continues

Sequestration mandatory payment reduction of two percent continues

For the Medicare fee-for-service (FFS) program, claims with dates-of-service or dates-of-discharge on or after April 1, 2013, will continue to incur a two percent reduction in Medicare payment through March 31, 2015. Claims for durable medical equipment (DME), prosthetics, orthotics, and supplies, including claims under the DME competitive bidding program, will continue to be reduced…

Method of Primary Care Incentive Payment (PCIP)

Method of Primary Care Incentive Payment (PCIP)

The following information is about Primary Care Incentive Payment Program PCIP 2017. Calculate and pay qualifying primary care practitioners an additional 10 percent incentive payment. Calculate the payment based on the amount actually paid for the services, not the Medicare approved amount. Combine the Primary Care Incentive Payment Program PCIP 2017 payments, when appropriate, with…