The CMS Quarterly Provider Update JULY 2011

Category: 

The Following Medicare Notices were published between July 5 and September 9

The Following Regulations affect ALL HOSPITALS

Medicare Program; Notification of Closure of St. Vincent’s Medical Center; Extension of the Deadline for Submission of Applications
http://www.gpo.gov/fdsys/pkg/FR-2011-09-09/html/2011-23120.htm

Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and FY 2012 Rates; Hospitals' FTE Resident Caps for Graduate Medical Education Payment
http://www.gpo.gov/fdsys/pkg/FR-2011-08-18/html/2011-19719.htm

2012 Annual Update for the Health Professional Shortage Area (HPSA) Bonus Payments
http://www.cmeonline.com/sites/default/files/downloads/2011/09/r2274cp.pdf

Inpatient Rehabilitation Facility (IRF) Annual Update: Prospective Payment System (PPS) Pricer Changes for FY 2012
http://www.cmeonline.com/sites/default/files/downloads/2011/09/r2275cp.pdf

Common Working File (CWF) Editing Update for Pulmonary Rehabilitation Services (PR) and Cardiac and Intensive Cardiac Rehabilitation Services
http://www.cmeonline.com/sites/default/files/downloads/2011/09/r941otn.pdf

Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2012; Changes in Size and Square Footage of Inpatient Rehabilitation Units and Inpatient Psychiatric Units
http://www.gpo.gov/fdsys/pkg/FR-2011-08-05/html/2011-19516.htm

Anesthesiologist Services in a Method II Critical Access Hospital (CAH)
http://www.cmeonline.com/sites/default/files/downloads/2011/09/r2268cp.pdf

Addition of Medical Severity Diagnosis Related Group (MS-DRG) 265 to the list subject to Inpatient Prospective Payment System (IPPS) Replaced Devices Offered Without Cost or With a Credit Policy
http://www.cmeonline.com/sites/default/files/downloads/2011/09/r922otn.pdf

Affordable Care Act – Section 3113 Laboratory Demonstration for Certain Complex Diagnostic Tests (This CR fully Rescinds and Replaces CR 7413)
http://www.cmeonline.com/sites/default/files/downloads/2011/09/r2261cp.pdf

Medicare Program; Hospital Inpatient Value-Based Purchasing Program; Correction
http://www.gpo.gov/fdsys/pkg/FR-2011-07-05/html/2011-16763.htm

Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2012 Rates; Corrections
http://www.gpo.gov/fdsys/pkg/FR-2011-07-13/html/2011-17672.htm

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The Following Regulations affect ALL PROVIDERS
Medicare Program; Changes to the Electronic Prescribing (eRx) Incentive Program
http://www.gpo.gov/fdsys/pkg/FR-2011-09-06/html/2011-22629.htm

Rate Increase Disclosure and Review: Definitions of “Individual Market” and “Small Group Market”
http://www.gpo.gov/fdsys/pkg/FR-2011-09-06/html/2011-22663.htm

Medicare Program; Medicare Advantage and Prescription Drug Benefit Programs
http://www.gpo.gov/fdsys/pkg/FR-2011-09-01/html/2011-22126.htm

Bundled Payments for Care Improvement Initiative: Request for Applications
http://www.gpo.gov/fdsys/pkg/FR-2011-08-25/html/2011-21707.htm

Summary of Benefits and Coverage and Uniform Glossary--Templates, Instructions, and Related Materials Under the Public Health Service Act
http://www.gpo.gov/fdsys/pkg/FR-2011-08-22/html/2011-21192.htm

Summary of Benefits and Coverage and the Uniform Glossary
http://www.gpo.gov/fdsys/pkg/FR-2011-08-22/html/2011-21193.htm

Medicare Fee-For-Service Claims Processing Guidance for Implementing International Classification of Diseases, 10th Edition (ICD-10)
http://www.cmeonline.com/sites/default/files/downloads/2011/09/r950otn.pdf

October Update to the CY 2011 Medicare Physician Fee Schedule Database (MPFSDB)
http://www.cmeonline.com/sites/default/files/downloads/2011/09/r2276cp.pdf

October 2011 Integrated Outpatient Code Editor (I/OCE) Specifications Version 12.3
http://www.cmeonline.com/sites/default/files/downloads/2011/09/r2277cp.pdf

Annual Clotting Factor Furnishing Fee Update 2012
http://www.cmeonline.com/sites/default/files/downloads/2011/09/r2279cp.pdf

Patient Protection and Affordable Care Act; Exchange Functions in the Individual Market: Eligibility Determinations; Exchange Standards for Employers
http://www.gpo.gov/fdsys/pkg/FR-2011-08-17/html/2011-20776.htm

Implementation of a Correction of Initial Default Values for Medically Unlikely Edits (MUEs)
http://www.cmeonline.com/sites/default/files/downloads/2011/09/r949otn.pdf

2012 Annual Update for the Health Professional Shortage Area (HPSA) Bonus Payments
http://www.cmeonline.com/sites/default/files/downloads/2011/09/r2274cp.pdf

Medicare Program; Accountable Care Organization Accelerated Development Learning Sessions; Center for Medicare and Medicaid Innovation, September 15th and 16th, 2011
http://www.gpo.gov/fdsys/pkg/FR-2011-08-12/html/2011-20543.htm

Medicare Program; Section 3113: The Treatment of Certain Complex Diagnostic Laboratory Tests Demonstration; Extension of the Deadline for Submission of Supporting Information
http://www.gpo.gov/fdsys/pkg/FR-2011-08-10/html/2011-20304.htm

Medicare and Medicaid Programs; Quarterly Listing of Program Issuances--January Through March 2011 and Proposal for Future Notices
http://www.gpo.gov/fdsys/pkg/FR-2011-08-08/html/2011-19954.htm

Reporting of Recoupment for Overpayment on the Remittance Advice (RA) with Patient Control Number
http://www.cmeonline.com/sites/default/files/downloads/2011/09/r940otn.pdf

Common Working File (CWF) Editing Update for Pulmonary Rehabilitation Services (PR) and Cardiac and Intensive Cardiac Rehabilitation Services
http://www.cmeonline.com/sites/default/files/downloads/2011/09/r941otn.pdf

Clarification of Payment for ESRD-Related Services Under the Monthly Capitation Payment
http://www.cmeonline.com/sites/default/files/downloads/2011/09/r2269cp.pdf

Group health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services Under the Patient Protection and Affordable Care Act
http://www.gpo.gov/fdsys/pkg/FR-2011-08-03/html/2011-19684.htm

Affordable Care Act – Section 3113 Laboratory Demonstration for Certain Complex Diagnostic Tests (This CR fully Rescinds and Replaces CR 7413)
http://www.cmeonline.com/sites/default/files/downloads/2011/09/r2261cp.pdf

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https://www.cms.gov/quarterlyproviderupdates/downloads/July11whatsnew.pdf

Transmittal 2263, entitled “Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), and Medicare Remit Easy Print (MREP) and PC Print Update” was published. This regulation affects ALL Providers.
View complete text of Transmittal 2263

Transmittal 2265, entitled “Quarterly Update to the Correct Coding Initiative (CCI) Edits, Version 17.3, Effective October 1, 2011” was published. This regulation affects Physicians.
View complete text of Transmittal 2265

View complete text of Transmittal 2260
Transmittal 2264, entitled “October 2011 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files” was published. This regulation affects Hospitals, Non-Physician Practitioners and Physicians.
View complete text of Transmittal 2264

Group Health Plans and Health Insurance Issuers: Rules Relating to Internal Claims and Appeals and External Review Processes; Correction
http://www.gpo.gov/fdsys/pkg/FR-2011-07-26/html/2011-18820.htm

07/25/2011
TRANSMITTAL(S) RELEASED
Transmittal 926, entitled “Medicare Remit Easy Print (MREP) and PC Print User Guide Update for Implementation of version 5010A1” was published. This regulation affects ALL Providers.
View complete text of Transmittal 926

Transmittal 927, entitled “Populating REF Segment – Other Claim Related Adjustment – for Healthcare Claim Payment/Advice or Transaction 835 version 5010A1” was published. This regulation affects ALL Providers.
View complete text of Transmittal 927

07/22/2011
TRANSMITTAL(S) RELEASED – CLARIFICATION
Transmittal 77, entitled “Method of Cost Settlement for inpatient Services for Rural Hospitals Participating Under Demonstrations Authorized by Section 410A of the Medicare Modernization Act. Sections 3123 and 10313 of the Affordable Care Act authorized an expansion of the demons” was published. This regulation affects Hospitals.
View complete text of Transmittal 77

TRANSMITTAL(S) RELEASED – MID-QUARTER
Transmittal 2257, entitled “Changes to the Laboratory National Coverage Determination (NCD) Edit Software for October 2011” was published. This regulation affects Clinical Diagnostic Laboratories, Hospitals, Independent Diagnostic Testing Facilities, Non-Physician Practitioners, Physicians, and Skilled Nursing Facilities.
View complete text of Transmittal 2257

Patient Protection and Affordable Care Act; Establishment of Consumer Operated and Oriented Plan (CO-OP) Program
http://www.gpo.gov/fdsys/pkg/FR-2011-07-20/html/2011-18342.htm

Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2012
http://www.gpo.gov/fdsys/pkg/FR-2011-07-19/html/2011-16972.htm

Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment; Ambulatory Surgical Center Payment; Hospital Value-Based Purchasing Program; Physician Self-Referral; and Provider Agreement Regulations on Patient Notification Requirements
http://www.gpo.gov/fdsys/pkg/FR-2011-07-18/html/2011-16949.htm

Patient Protection and Affordable Care Act; Standards Related to Reinsurance, Risk Corridors and Risk Adjustment
http://www.gpo.gov/fdsys/pkg/FR-2011-07-15/html/2011-17609.htm

Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans
http://www.gpo.gov/fdsys/pkg/FR-2011-07-15/html/2011-17610.htm

Administrative Simplification: Adoption of Operating Rules for Eligibility for a Health Plan and Health Care Claim Status Transactions
http://www.gpo.gov/fdsys/pkg/FR-2011-07-08/html/2011-16834.htm

Medicare Program; Section 3113: The Treatment of Certain Complex Diagnostic Laboratory Tests Demonstration
http://www.gpo.gov/fdsys/pkg/FR-2011-07-05/html/2011-16721.htm