Healthcare Business Management Association



Washington Report – April, 2014

(Covers activity between 4/1/14 and 4/30/14)

Bill Finerfrock, Matt Reiter, Lara Burt and Carolyn Bounds

HHS Announces Intent to set new ICD-10 date

CMS Releases Medicare Billing Data from 2012

Agreement in Principle on Patent Troll Bill

MU Hardship Exception Applications due July 1, 2014

Blum Announces Resignation as CMS Principal Deputy Administrator

Health Subcommittee Holds Hearing on Ideas to Improve Medicare Oversight To Reduce

Waste, Fraud and Abuse

Medicare Advantage Plans to See Increased Payments After All

Sylvia Mathews Burwell nominated as Kathleen Sebelius' Replacement as HHS Secretary

RUC Reform On Congress’ Radar Screen

The Costs of Medicare Readmissions

CMS Transmittals

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HHS Announces new ICD-10 Effective date

As has been previously reported, on April 1, 2014, the Protecting Access to Medicare Act of 2014 was enacted, which specified that the Secretary may not adopt ICD-10 prior to October 1, 2015. This left some uncertainty as to what the new date would be exactly.

Recently, the Department of Health and Human Services (HHS) announced that they intend to release an interim final rule in the near future that will include a new compliance date that would require the use of ICD-10 beginning October 1, 2015. The rule will also require HIPAA covered entities to continue to use ICD-9-CM through September 30, 2015.

In addition, HHS announced that the previously planned ICD-10 end-to-end testing CMS intended to conduct during the week of July 21 through 25, 2014, was being postponed to a date yet to be determined. In making the announcement, however, HHS did state that “Additional opportunities for end-to-end testing will be available in 2015.”

The use of the plural “opportunities” at least suggests that there will be more than one opportunity for end-to-end testing in 2015.

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CMS Releases Medicare Billing Data from 2012

For the first time in its history, The Centers for Medicare and Medicaid Services released billing data on every individual physician for Medicare services provided in 2012. The data represents 880,000 health care professionals in all 50 states who collectively received $77 billion in payments in 2012 for services delivered to beneficiaries under the Medicare Part B Fee-For-Service program. The data is organized both by individual provider and by service code.

CMS released this information with the intention that it will help patients make more informed decisions when choosing providers and further support CMS’ various transparency initiatives. No beneficiary personal identifiable information is included.

The medical community expressed concerns with this information release. Mainly, that the data would be misinterpreted and misconstrued to make providers seem greedy or perhaps engaging in fraud or abuse. Since the data only provides aggregate data for the entire year, it is difficult to find the proper context for what the numbers really mean for a physician’s practice. Similarly, this aggregate data does not provide enough context to help inform beneficiaries in the way CMS believes it will.

The data includes the 2012 total amount a doctor billed Medicare, the 2012 total allowable amount and the 2012 total amount paid by Medicare.

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Agreement in Principle on Patent Troll Bill

The Senate Judiciary Committee has reached an “agreement in principle” on S. 1720, the Patent Transparency and Improvements Act of 2013. This bill aims to crack down on “patent trolls.” Patent trolls collect vaguely worded patents and sue companies for infringement as a way of forcing them into settlements or licensing fees. Some billing companies have been threatened with “patent troll” lawsuits over various aspects of medical billing and other uses of technology.

The bill was scheduled to be marked up by the Judiciary Committee but the markup was pushed back until after the Easter Recess.

In December, the House of Representatives passed a similar bill H.R. 3309, the Innovation Act, with wide bipartisan support.

Lawmakers have struggled to find a balance between punishing patent abusers while maintaining the intellectual property protections patents are intended for. One of the major issues to overcome is a provision in the House bill that would require the loser in patent infringement cases to pay the winning side’s costs. The provision is intended to discourage frivolous patent infringement claims by making them much more financially risky for plaintiffs. Some Democrats are concerned this provision goes too far for legitimate patent holders.

Some of the Senate bill provisions include:

• Require a patentee who has filed a civil action for patent infringement to disclose to the court and to all adverse parties any persons, associations, corporations (including parent corporations), or other entities known by the patentee to have: (1) a financial interest in the subject matter in controversy or in a party to the proceeding, or (2) any other interest that could be substantially affected by the outcome of the proceeding.

• Requires a patentee who unsuccessfully sues an infringer to reimburse the successful party for legal fees.

• Requires the Federal Trade Commission (FTC) to: (1) exercise enforcement authority with respect to bad-faith demand letters (widespread written communications with false or misleading information stating that the intended recipients or affiliated persons are infringing or have infringed a patent and bear liability or owe compensation), and (2) treat such letters as unfair or deceptive acts or practices.

• Directs the USPTO to notify the public on its website when a patent case is brought in federal court.

While there is momentum within the Senate Judiciary committee, there is still much work to be done before this bill is voted on by the Committee and referred to be brought up by the full Senate.

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MU Hardship Exception Applications due July 1, 2014

Medicare providers who are unable to successfully demonstrate meaningful use for 2013 due to circumstances beyond their control can apply for a “hardship exemption.” CMS is accepting applications for hardship exceptions to avoid the upcoming Medicare payment reductions for the 2013 reporting year.

Applications for the 2015 payment adjustments are due July 1, 2014 for eligible professionals. If approved, the exception is valid for one year.

Medicare payment reductions for failure to be an EHR meaningful user will begin on January 1, 2015 for eligible professionals. CMS has prepared a hardship exceptions “tip sheet” to help providers know their options.

Completing a hardship exception application and providing the documentation necessary to support that claim, does not guarantee that the provider will be granted the exception. CMS will review applications to determine whether or not the provider should be granted a hardship exception.

CMS has posted hardship exception applications on the EHR website for:

Eligible professionals

Eligible professionals submitting multiple National Provider Identifiers (NPIs)

The Medicare and Medicaid EHR Incentive Program website is a useful place to go for more information about the Medicare and Medicaid EHR incentive programs.

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Sylvia Mathews Burwell nominated as Kathleen Sebelius' Replacement as HHS Secretary

On April 11, Health and Human Services Secretary Kathleen Sebelius announced her resignation, after five years of serving the Obama administration. At a Rose Garden ceremony, President Obama praised the outgoing Sebelius and declared that she would “go down in history” as the health and human services secretary serving when the country “finally declared that quality affordable healthcare is not a privilege, but a right for every single citizen”.

Sebelius, the former governor of Kansas, and, before that, state insurance commissioner, has served as the HHS Secretary since shortly after President Obama came into office in 2009 and was instrumental in the transition and implementation of the Affordable Care Act (ACA). However, Sebelius’ tenure was marred by technical problems that crippled , the website set up to enroll Americans in insurance exchanges, for which she received harsh criticism.

Sebelius had notified the President in early March of her plans to resign. She felt that the Affordable Care Act trajectory was back on track, after a rough start, and believed “that once open enrollment ended it would be the right time to transition the Department to new leadership.”

To replace Sebelius, President Obama nominated the Director of the Office of Management and Budget, Sylvia Mathews Burwell, calling her "a proven manager" who knows how to get results. If confirmed, Burwell, would bring a background in economics and management to the health position. Burwell, is a former president of the Bill and Melinda Gates foundation, and former president of the Wal Mart foundation. She has served as deputy White House chief of staff during the Clinton administration and in top roles at the Treasury Department and the National Economic Council. Burwell has been heading the Office of Management and Budget for approximately one year.

If confirmed as HHS Secretary, Burwell will face the challenges of keeping the complex agency running smoothly and having to ensure that the next open enrollment period on the health insurance exchanges goes more smoothly than the last.

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Blum Announces Resignation as CMS Principal Deputy Administrator

Earlier this month, Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner announced the resignation of Jonathon Blum, principal deputy administrator at CMS. News of Blum’s decision to step down came shortly after Kathleen Sebelius resigned as HHS secretary earlier this month. His last day on the job will be May 16.

Blum was President Obama’s first political appointee to CMS, serving as director of the Center for Medicare from 2009 to 2013. Last year, he was promoted to principal deputy administrator of the CMS, the second highest position in CMS. Before this position Blum worked as a program analyst at the Office of Management and Budget, focusing on Medicare. He also worked on the staff of the Senate Finance Committee for then-Chairman Sen. Max Baucus, (D-MT.)

During his five-year tenure, Blum was integral in the implementation of many significant Medicare reforms. He was considered instrumental in Medicare’s accomplishments including developing accountable care organizations (ACO) regulations, implementing quality framework for Medicare Advantage plans, and developing many of CMS’ value-based payment strategies. Most recently, Blum oversaw the release of Medicare billing data of about 825,000 physicians, which showed for the first time how individual medical providers bill for services provided to America's seniors and the disabled.

In making the announcement, CMS Administrator Marilyn Tavenner, noted that Blum will be leaving “to pursue new opportunities.” 

Blum will be succeeded by Center for Medicare and Medicaid Innovation Deputy Director, Sean Cavanaugh. Previously, Cavanaugh was director of health care finance at the United Hospital Fund in New York City. He has also served in senior positions at Lutheran Healthcare (Brooklyn, NY), the New York City Mayor’s Office of Health Insurance Access, and the Maryland Health Services Cost Review Commission. He started his career on Capitol Hill working for a member of the Ways and Means Health Subcommittee.

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Health Subcommittee Holds Hearing on Ideas to Improve Medicare Oversight To Reduce Waste, Fraud and Abuse

On April 30th, the House Committee on Ways and Means Subcommittee on Health held a hearing to solicit input from the HHS Inspector General’s office (OIG), CMS and the Government Accountability Office (GAO) on ways to improve Medicare oversight and reduce waste, fraud and abuse. Gloria Jarmon, Deputy Inspector General for Audit Services, Office of Inspector General, testified on behalf of HHS; Shantanu Agrawal, M.D., Deputy Administrator and Director, Center for Program Integrity, testified on behalf of CMS; and Kathy King, Director, Health Care testified on behalf of GAO.

According to the OIG, in FY 2013, Medicare made $50 Billion in improper payments to providers. The OIG identified three areas CMS can improve in,

(1) Ineligible beneficiaries;

(2) Payments for prescription drugs; and

(3) Payments to hospitals.

OIG found that CMS processes were not efficient enough to detect and recoup improper payments in a timely manner. OIG also highlighted how CMS does not have policies in place to notify Part C plans of data that could be used to prevent improper payments or to identify and reject prescription drug claims associated with ineligible beneficiaries. The OIG found several instances where Medicare made payments to beneficiaries who were terminated from Medicare or who are deceased.

The OIG urged CMS to improve its policies and procedures for detecting and recouping these improper payments in a timely manner. OIG also recommended that CMS strengthen oversight of contractors. CMS also does not currently require Part C and D plans to report fraud and abuse data. OIG recommended they change this policy.

During their testimony, CMS highlighted its efforts to strengthen Medicare-Medicaid (Medi-Medi) data sharing to prevent and combat waste, fraud and abuse. It also highlighted its efforts to prevent identity theft of beneficiaries. CMS also described its Fraud Prevention System (FPS) to predict, model, analyze and ultimately prevent potential waste fraud and abuse. CMS also discussed the National Correct Coding Initiative (NCCI), which consists of edits designed to reduce improper payments in Part B and Medicaid.

The NCCI program was implemented with procedure-to-procedure edits to ensure accurate coding and reporting of services by physicians. According to Dr. Agrawal’s testimony, the program saved CMS an estimated $483M in 2012.

GAO acknowledged CMS’ efforts to prevent waste, fraud and abuse but recommended where more can be done to improve program integrity. In studying CMS’ waste, fraud and abuse procedures, GAO found that stricter pre-payment review edits and post-payment edits for recovery were effective tools for reducing waste, fraud and abuse. GAO also identified various vulnerabilities in CMS’ procedures that need to be addressed such as removing Social Security Numbers from beneficiaries’ Medicare cards.

GAO also recommended that CMS strengthen provider enrollment standards and procedures. GAO mentioned Recovery Audit Contractors (RACs) as “helpful” to the agency’s recovery efforts. It noted that RACs collected $816M in FY2013. While there is a current pause in RAC efforts to accommodate the backlog of claims and go through the latest round of contract procurement, CMS anticipates it will award all five FFS contracts by the end of summer, 2014.

GAO did testify that the agency is examining CMS’ oversight of some of the contractors that conduct reviews of claims after payment.

The Committee Members made a rare display of bipartisanship over improving Medicare program integrity. There was vast consensus that some of the more glaring issues needed to be addressed. The Members were particularly displeased with how much money Medicare paid to deceased, terminated and ineligible beneficiaries. They also believed that removing Social Security Numbers from Medicare cards was a crucial measure that had to be taken and were not happy to hear CMS pushback that it would be too costly of a measure. The committee also pressed CMS to take the recommendations from OIG and GAO seriously. They called for better collaboration and stronger responses to CMS’ vulnerabilities. According to the Committee Members, this will certainly not be the last hearing on this topic.

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Medicare Advantage Plans to See Increased Payments After All

After months of speculation that CMS would reduce Medicare payments to Medicare Advantage plans for 2015, CMS announced that plans would receive 0.4 percent boost in their payment rates next year.

According to CMS officials, the increase occurred in part due to healthier enrollees signing up for both Medicare Advantage and traditional fee-for-service plans, resulting in lower spending on the health insurance system for the aged.

CMS had come under intense pressure from both health plans and many Members of Congress from both parties prior to releasing the final rate announcement.

The rate announced in the “Call Letter” is an estimate of the overall net change for plans’ payments in 2015. Individual plan payments will vary based on various geographic and demographic factors.

According to the preliminary assessment issued by CMS earlier this year, the Medicare Advantage rate was going to be reduced by an average of 1.9 percent compared to 2014 rates.

According to a statement released by CMS, the changes that were primarily responsible for the change in payment rates were:

• A new projection for Medicare’s growth trend factor

• A revised risk adjustment methodology to account for the influx of baby boomers in the Medicare program

• A CMS decision to phase-in a new MA risk adjustment model that began this year and is used to adjust plan payments and bids based on enrollees’ health status and demographic characteristics.

• A delay in a new policy limiting how MA plans use in-home wellness or risk assessment visits to adjust the payments they receive.

Finally, CMS announced that enrollment in Medicare Advantage plans had grown by more than 5 percent compared to last year.

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RUC Reform On Congress’ Radar Screen

On April 17 a bipartisan group of lawmakers sent a letter to CMS Administrator Marilyn Tavenner urging her to make public the process of setting values for physician services (AKA the RUC process). This letter was similar to a letter sent by a group of House Democrats on April 8.

Language directing CMS to make changes in so-called “Misvalued” codes was included in the SGR patch signed into law earlier this month.

Some physician organizations and media outlets have blamed the American Medical Association's Relative Value Scale Update Committee (RUC) for contributing to the underpayment of primary care services and overpayment for high-end specialties. In 2013, the Washington Post published several articles that were highly critical of the RUC process. The AMA, for its part, released a detailed rebuttal of the Post articles.

The Representatives signing the letter want CMS to use their rulemaking authority to set values for physician services. Typically CMS has used an abbreviated rulemaking process to adopt the RUC recommendations. This abbreviated process did not give physicians much time to review and comment on the RUC recommendations.

Although the RUC is technically an advisory panel to CMS, historically, CMS has adopted the vast majority of recommendations made by the RUC in terms of the value of physician services. Only recently has CMS begun to scrutinize the RUCs recommendations.

Regular rulemaking would give physicians and others who have a vested interest in this issue additional time to respond to proposed changes to billing and give them more time to prepare for billing changes, the lawmakers state.

Should CMS fail to take the administrative actions being recommended, it is quite possible Congress would begin to actively consider legislation mandating that CMS adopt the administrative changes.

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The Costs of Medicare Readmissions

Health Policy experts have long criticized the Medicare policy of paying for hospital readmissions, arguing that such payments effectively reward improper care. And even though CMS has taken steps to discontinue this practice, according to a recent paper released by the Agency for Healthcare Research and Quality (AHRQ), the cost of this policy was staggering: in 2011, $41.3 Billion in hospital readmission payments in total, of which nearly 60% were for readmissions of Medicare patients.

All told, Medicare patients represented 56 percent of all readmissions in 2011.

Here are the costs of the 10 most common Medicare readmissions, according to the AHRQ brief.

A readmission was defined as a patient who was hospitalized within 30 days of a previous hospital admission.

1. Congestive heart failure

2. Septicemia

3. Pneumonia

4. Chronic obstructive pulmonary disease and bronchiectasis

5. Cardiac dysrhythmias

6. Complication of device, implant or graft

7. Heart attack

8. Acute and unspecified renal failure

9. Urinary tract infections

10. Acute cerebrovascular disease

Other finding from the report:

* In 2011, there were approximately 3.3 million adult hospital readmissions in the United States, and they were associated with about $41.3 billion in hospital costs.

* For Medicare patients, the three conditions with the largest number of readmissions were congestive heart failure (134,500 readmissions), septicemia (92,900 readmissions), and pneumonia (88,800 readmissions). These conditions resulted in about $4.3 billion in hospital costs.

* For Medicaid patients, the three conditions with the largest number of readmissions were mood disorders (41,600 readmissions), schizophrenia (35,800 readmissions), and diabetes (23,700 readmissions). These conditions resulted in about $839 million in hospital costs.

* For the privately insured, the three conditions with the largest number of readmissions were maintenance chemotherapy (25,500 readmissions), mood disorders (19,600 readmissions), and complications of surgical or medical care (18,000 readmissions). These conditions resulted in about $785 million in hospital costs.

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CMS Transmittals

The following Transmittals were issued by CMS during the month of April.

|Transmittal Number |Subject |Effective Date |

|R1378OTN |Implement Operating Rules - Phase III ERA EFT: CORE 360 Uniform Use of Claim Adjustment Reason Codes |  N/A |

| |(CARC) and Remittance Advice Remark Codes (RARC) Rule - Update from CAQH CORE - June 1, 2014 version | |

| |3.0.5 | |

|R1379OTN |Anesthesiologist/Certified Registered Nurse Anesthetist (CRNA) Related Services in a Method II Critical|10/6/2014 |

| |Access Hospital (CAH) | |

|R1380OTN |Present on Admission (POA) Indicator Editing for Maryland Waiver Hospitals |10/6/2014 |

|R28COM |Revision of Pub. 100-09, Chapter 6, Medicare Contractor Beneficiary and Provider Communications Manual;|7/2/2014 |

| |Clearance of MAC Internet-Based Provider Portal Handbook; and Deletion of IOM Pub. 100-09, Chapter 3, | |

| |Provider Inquiries. | |

|R2947CP |Medicare System Updates to Include Splints, Casts and Certain Intraocular Lenses Payment Category |10/6/2014 |

| |Indicators in the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule| |

| |File and Alpha-Numeric HCPCS file | |

|R2948CP |Calendar Year (CY) 2014 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services |6/30/2014 |

| |Subject to Reasonable Charge Payment - REVISION | |

|R514PI |Update to CMS Publication 100-08, Chapter 15 |6/3/2014 |

|R1374OTN |Health Insurance Portability and Accountability Act (HIPAA) EDI Front End Updates for October 2014 |10/6/2014 |

|R1375OTN |Adding New MSP Data Fields to the CWF Daily File |10/6/2014 |

|R1376OTN |Return Maintenance of the ANSILIST to the Durable Medical Equipment (DME) Medicare Administrative |10/6/2014 |

| |Contractors (MACs). | |

|R1377OTN |Hewlett Packard Enterprise Services, LLC (HPES) Shared Systems Maintainer (SSM) support for Medicare |10/6/2014 |

| |Administrator Contractors (MACs) testing and inquiries for the Combined Common Edits/Enhancements | |

| |Module (CCEM) for Part A and Part B | |

|R187BP |Update to the Medicare Benefit Policy Manual to Restore Missing Air Ambulance Definitions |8/4/2014 |

|R188BP |Updates and Clarifications to the Hospice Policy Chapter of the Benefit Policy Manual |8/4/2014 |

|R2940CP |Quarterly Update for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) |7/7/2014 |

| |Competitive Bidding Program (CBP) - July 2014 | |

|R1373OTN |CWF Editing for Vaccines Furnished at Hospice - Correction |4/7/2014 |

|R113SOMA |New Guidance Added to Chapter 7 – Survey and Enforcement Process for Skilled Nursing Facilities and |1/1/2012 |

| |Nursing Facilities | |

|R114SOMA |New to State Operations Manual (SOM) Chapter 10 |4/25/2014 |

|R2936CP |July 2014 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior|7/7/2014 |

| |Quarterly Pricing Files | |

|R2937CP |Medicare Claims Processing Pub. 100-04 Chapter 31 Update |4/14/2014 |

|R1371OTN |Instructions to Contractors for Implementing Section 5506 of the Affordable Care Act (ACA) – |5/19/2014 |

| |Preservation of Resident Cap Positions from Closed Teaching Hospitals – Rounds 1, 2, 3 and After | |

|R166NCD |Fluorodeoxyglucose (FDG) Positron Emission Tomography (PET) for Solid Tumors (This CR rescinds and |  N/A |

| |fully replaces CR8468/TR2873 dated February 6, 2014) | |

|R2932CP |Fluorodeoxyglucose (FDG) Positron Emission Tomography (PET) for Solid Tumors (This CR rescinds and |  N/A |

| |fully replaces CR8468/TR2873 dated February 6, 2014) | |

|R512PI |Revision to the Program Integrity Manual, Chapter 3 Section 3.3 |5/19/2014 |

|R2933CP |Addition of New Fields and Expansion of Existing Model 1 Discount Percentage Field in the Inpatient |7/7/2014 |

| |Hospital Provider Specific File (PSF) and Addition of New Fields and Renaming Payment Fields in the | |

| |Inpatient Prospective Payment System (IPPS) Pricer Output | |

|R186BP |Clarification to Pub. 100-02, Medicare Benefit Policy Manual Regarding Antigens and Deletion of Section|5/12/2014 |

| |13.14 from Chapter 13 of Pub. 100-08, Medicare Program Integrity Manual | |

|R165NCD |Aprepitant for Chemotherapy-Induced Emesis |7/7/2014 |

|R185BP |Aprepitant for Chemotherapy-Induced Emesis |7/7/2014 |

|R2931CP |Aprepitant for Chemotherapy-Induced Emesis |7/7/2014 |

|R108SOMA |State Operations Manual (SOM) Exhibit 185 Revisions For Intermediate Care Facilities For Individuals |4/11/2014 |

| |With Intellectual Disabilities (ICF/IID) | |

|R109SOMA |State Operations Manual (SOM) Appendix T Revisions For Intermediate Care Facilities For Individuals |4/11/2014 |

| |With Intellectual Disabilities (ICF/IID) | |

|R110SOMA |State Operations Manual (SOM) Appendix W Revisions For Intermediate Care Facilities For Individuals |4/11/2014 |

| |With Intellectual Disabilities (ICF/IID) | |

|R111SOMA |State Operations Manual (SOM) Chapter 2 policy revisions for Organ Procurement Organizations (OPOs) |4/11/2014 |

|R112SOMA |State Operations Manual (SOM) Chapter 3 policy revisions for Organ Procurement Organizations (OPOs) |4/11/2014 |

|R184BP |Clarification to Pub. 100-02, Medicare Benefit Policy Manual Regarding Antigens and Deletion of Section|5/12/2014 |

| |13.14 from Chapter 13 of Pub. 100-08, Medicare Program Integrity Manual | |

|R234FM |Notice of New Interest Rate for Medicare Overpayments and Underpayments - 3rd Qtr Notfication for FY |4/17/2014 |

| |2014 | |

|R2926CP |Chapter 29 Appeals Update (Includes Post-DOMA Guidance and Signature Requirement for Appointment of |7/14/2014 |

| |Representatives and Assignment of Appeal Rights) | |

|R2930CP |Denial Letters for Religious Nonmedical Health Care Institution Services Not Covered by Medicare |7/14/2014 |

|R510PI |Clarification to Pub. 100-02, Medicare Benefit Policy Manual Regarding Antigens and Deletion of Section|5/12/2014 |

| |13.14 from Chapter 13 of Pub. 100-08, Medicare Program Integrity Manual | |

|R98DEMO |Affordable Care Act Bundled Payments for Care Improvement Initiative - Recurring File Updates Models 2 |7/7/2014 |

| |and 4 July 2014 Updates | |

|R1369OTN |Clarification of Remittance Advice Code Combination Reports Generated by Shared Systems |  N/A |

|R1370OTN |Implement Operating Rules - Phase III ERA EFT: CORE 360 Uniform Use of Claim Adjustment Reason Codes |  N/A |

| |(CARC) and Remittance Advice Remark Codes (RARC) Rule - Update from CAQH CORE - February 1, 2014 | |

| |version 3.0.4 | |

|R2927CP |April 2014 Update of the Ambulatory Surgical Center (ASC) Payment System |4/7/2014 |

|R2928CP |Enforcement of the 5 day Payment Limit for Respite Care Under the Hospice Medicare Benefit |7/7/2014 |

|R2929CP |Update to Pub. 100-04, Medicare Claims Processing Manual, Chapter 11 to Provide Language-Only Changes |10/1/2014 |

| |for Updating ICD-10 and ASC X12 | |

|R1367OTN |Implementation of NACHA Operating Rules for Health Care Electronic Funds Transfers (EFT) |4/7/2014 |

|R1366OTN |Termination of the Common Working File ELGA, ELGH, HIQA, HIQH, and HUQA Part A Provider Queries |4/7/2014 |

|R106SOMA |State Operations Manual (SOM) Appendix P revisions for Intermediate Care Facilities for Individuals |4/4/2014 |

| |with Intellectual Disabilities (ICF/IID | |

|R107SOMA |State Operations Manual (SOM) Appendix PP LTCF revisions for Intermediate Care Facilities for |4/4/2014 |

| |Individuals with Intellectual Disabilities (ICF/IID) | |

|R183BP |Internet Only Manual Updates to Pub. 100-1, 100-2 and 100-4 to Correct Errors and Omissions |5/5/2014 |

|R233FM |Revisions and Deletions to the Internet Only Manual, Publication 100-06, Chapter 4, Debt Collection |7/7/2014 |

| |(Section 10) | |

|R2919CP |New Waived Tests |7/7/2014 |

|R2920CP |Remittance Advice Remark and Claims Adjustment Reason Code and Medicare Remit Easy Print and PC Print |7/7/2014 |

| |Update | |

|R2921CP |Internet Only Manual Updates to Pub. 100-1, 100-2 and 100-4 to Correct Errors and Omissions |5/5/2014 |

|R2923CP |April Update to the CY 2014 Medicare Physician Fee Schedule Database (MPFSDB) |4/7/2014 |

|R84GI |Internet Only Manual Updates to Pub. 100-1, 100-2 and 100-4 to Correct Errors and Omissions |5/5/2014 |

|SE1416 |Updating Beneficiary Information with the Benefits Coordination & Recovery Center (formerly known as | |

| |the Coordination of Benefits Contractor) | |

|R2922CP |Medicare Claims Processing Pub. 100-04 Chapter 25 Update |4/18/2014 |

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