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OPPS – April 2012 Update

From: CMS Transmittal 2418 (Medicare Claims Processing) – 3/2/12

Transmittal Summary of Changes

 This Recurring Update Notification describes changes to and billing instructions for various payment policies implemented in the April 2012 OPPS update. The April 2012 Integrated Outpatient Code Editor (I/OCE) and OPPS Pricer will reflect the Healthcare Common Procedure Coding System (HCPCS), Ambulatory Payment Classification (APC), HCPCS Modifier, and Revenue Code additions, changes, and deletions identified in this Change Request (CR).

From: CMS Transmittal 2395 (Pub 100-04) – 1/26/12

Summary of Changes

This instruction implements the Multiple Payment Reduction (MPPR) for physician services for certain diagnostic imaging procedures in CAHs.

From: CMS Transmittal 2393 (Pub 100-04) – 1/25/12

Summary of Changes

The purpose of this Change Request (CR) is to provide IRF hospitals updated instructions on submission of “no-pay” bills to Medicare for Medicare Advantage (MA) patients.

From: CMS Transmittal 1017 (Pub 100-20) – 1/24/12

Summary of Changes

This transmittal replaces Transmittal 1014 dated January 6, 2012 to correct  the effective date of the implementation of this ruling.  The corrected effective date is January 30, 2012.  The transmittal involves instructions to contractors to inform teaching hospitals of the proper way to report the FICA refund for medical residents on the Medicare cost report.

From: CMS Transmittal 2388 (Pub 100-04) – 1/20/12

Summary of Changes

CMS is clarifying  billing instructions to Pub 100-04, Medicare Claims Processing Manual, Chapter 3, Inpatient Hospital Billing, Section 40, Billing Coverage and Utilization Rules for PPS and Non-PPS Hospitals when life time reserve (LTR) days exhaust during the nonoutlier portion of an Inpatient Prospective Payment System (IPPS) stay.

From: CMS Transmittal 2379 (Pub 100-04)- 1/18/12

CMS Summary of Changes

This Change Request (CR) provides a summary of the policies in the CY 2012 Medicare Physician Fee Schedule Final Rule and announces the Telehealth Originating Site Facility Fee payment amount for CY 2012. The attached Recurring Update Notification applies to Publication 100-04, Chapter 12, Section 190.6 and Publication 100-02, Chapter 15, Section 270.5

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Transmittal 78 – Pub. 100-07 – 12/22/11

CMS released this transmittal update to reflect regulatory changes related to the provision of telemedicine services in Hospitals and CAHs.

Transmittal 3 – December 2011

This transmittal impacts SNF cost reporting periods beginning on or after January 1, 2012.  It incorporates a revision required by ACA Section 6104 “Reporting of Direct Care Expenditures.” 

This ACA provision requires SNFs to separately report expenditures for wages and benefits for direct care staff (breaking out (at a minimum) registered nurses, licensed professional nurses, certified nurse assistants, and other medical and therapy staff).  A new cost report form was added S-3, Part V for the collection of this data.  Several other changes/clarification were made in and described in this transmittal.

Read more:

SNF Cost Report Forms CMS-2540-10

Update to Medicare Deductible, Coinsurance & Premium Rates for 2012

CMS Transmittal 72 – 11/18/11

This transmittal contains the CY 2012 Deductible and Coinsurance amounts.

RHC/FQHC Payment Rate Increases – CY 2012

CMS Transmittal R2343CP – 11/04/11

RHC/FQHC payment rates will be increased by 1.8% beginning January 1, 2012.  Listed below are the updated payment rates provided in this transmittal: