Washington Report – July, 2012



Washington Report – August, 2012

Bill Finerfrock, Pam Jackson, Zhaneta Mansaku and Kristen Metzger

HBMA Comments on 2013 MPFS Proposed Changes

CMS Primary Care Demonstration participants

HHS issues EFT/ERA Operating rules

Medicare Costs going down, SGR cut could be lower

ONC/CMS Announce Stage II Meaningful Use Criteria

CMS Announces Improvements to PECOS

HHS Announces New ICD-10 Compliance Date

HHS Announces New Rules for Health Plan Identifiers (HPID) and “Other Entity” Identifiers

NPI Database: GAO raises identity theft concerns

RAC Denials on the Rise

It’s Not Too Late to Sign-Up for PQRS bonus payments

CMS Transmittals

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HBMA Comments on 2013 MPFS Proposed Changes

The Healthcare Billing and Management Association along with hundreds of other health professional and healthcare related organizations submitted comments in response to proposed changes in the Medicare Physician Fee Schedule (MPFS).

Upon publication of the Notice of Proposed Rulemaking (NPRM), HBMA staff prepared a memo summarizing the nearly 800 page publication. Based upon this summary, the HBMA Government Relations Committee identified the key issues the Association would comment on and formed a workgroup to develop the Association’s comments.

As is the case with most NPRM’s the public was given 60 days to review, analyze and develop comments on the proposal. In addition to raising concerns about the pending 27% cut in physician fee schedule payments due to the SGR policy, some of the other issues covered in HBMA’s comments were:

A. Any consideration of expansion of the Multi-Procedure Payment Reduction (MPPR) policy to the professional component of other diagnostic procedures or other specialties should be suspended, until such time as there is independent research to support the underlying assumption. CMS should solicit input from industry stakeholders to obtain relevant cost data to objectively test the assumptions regarding provider cost savings and associated discount to the program.

B. CMS must issue policy clarification as it relates to coding for MPPR. Use of the Modifier 59 to identify services subject to the MPPR payment reduction, conflicts with CCI edit policy relative to the appropriate use of Modifier 59 when NO payment reduction is necessary.

C. CMS should rescind the proposed policy regarding the lifting of prepayment review limits and maintain the current regulatory policy that mandates that contractors must terminate the non-random prepayment complex medical review of a provider no later than 1 year following the initiation of the complex medical reviewer when calculation of the error rate indicates the provider or supplier has reduced its initial error rate by 70 percent or more.

D. CMS should withdraw the proposed therapy documentation and reporting requirements and instead, CMS should solicit input from the therapy community regarding the most effective tools to assess patient progress and base any future proposed changes on proven quality of care improvements, not data gathering.

CMS will review all of the comments submitted by the September 4th deadline and announce their new policies in early November.

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CMS Primary Care Demonstration participants

According to a press release issued by CMS, 500 primary care practices in seven regions have been selected to participate in a new partnership between CMS, state Medicaid agencies, commercial health plans and self-insured businesses. 

This partnership is “designed to provide improved access to quality health care at lower costs.”

Under the Comprehensive Primary Care Initiative, CMS will pay the selected practices a care management fee, initially set at an average of $20 per beneficiary per month, to support “enhanced, coordinated services on behalf of Medicare fee-for-service beneficiaries.”  Participating commercial, state, and other federal insurance plans will also offer enhanced payments to these primary care practices for the same types of patient care management services. 

The initiative was announced in the fall of 2011 when CMS solicited commercial health plans, state Medicaid agencies, and self-insured businesses to partner with Medicare to support comprehensive primary care. Health plans in Arkansas, Colorado, New Jersey, Oregon, New York, Ohio, Kentucky and Oklahoma signed letters of intent with CMS to participate in this initiative. 

Primary care practices in each market were then invited to apply to participate and start delivering enhanced health care services this fall.  Practices were chosen based on their use of health information technology, their ability to demonstrate recognition of advanced primary care delivery by leading clinical societies, service to patients covered by participating payers, participation in practice transformation and improvement activities, and geographic diversity.

In making the announcement, Acting CMS Administrator Marilyn Tavenner said, “Primary care practices play a vital role in our health care system and we are looking at ways to better support them in their efforts to coordinate care for their patients.”

If you would like more information, please go to Primary Care Initiative.

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HHS issues EFT/ERA Operating rules

On August 24th, the Department of Health and Human Services issued the final operating rules for Electronic Fund Transfers (EFT) and Electronic Remittance Advice (ERA). In releasing the final rule, HHS Secretary Kathleen Sebelius said, “These new rules will cut red tape, save money and ensure doctors spend more time seeing patients and less time filling out forms.”

According to research reviewed by HHS, on average, a physician spends three weeks a year on billing and insurance related tasks. Furthermore, in a physician’s office, “two-thirds of a full-time employee per physician is necessary to conduct these tasks.”

Despite widespread use of electronic transactions in most other areas of commerce, HHS found that many physician practices continue to receive and deposit paper checks, and manually post and reconcile the health care claim payments in their accounting systems.

The new EFT operating rules are built upon the EFT standards announced earlier this year by HHS. According to the HHS announcement, those standards, in combination with these new operating rules, are projected to save between $2.7 billion and $9 billion in administrative costs over ten years. The majority of the savings will be realized by reducing inefficient manual administrative processes for physician practices, hospitals, and health plans.

The new operating rules will require insurers to offer a standardized, online enrollment for EFT and ERA so that physicians can more easily enroll with multiple health plans to receive those transactions electronically. The new rules also require health plans to send the EFT within a specified number of days sending the ERA. It is expected that this will help providers (and billing companies) reconcile accounts more quickly.

These new rules were developed with significant input from industry stakeholders, including HBMA. The rule adopts the Council for Affordable Quality Healthcare's (CAQH) Committee on Operating Rules for Information Exchange (CORE) Operating Rule Set.

The compliance date for operating rules for the health care electronic funds transfers and remittance advice transaction is Jan. 1, 2014.

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Medicare Costs going down, SGR cut could be lower

According to the non-partisan Congressional Budget Office, the economic recovery that is currently underway will “continue at a modest pace for the remainder of calendar year 2012, with real (inflation-adjusted) GDP growing at an annual rate of about 2¼ percent in the second half of the year, compared with a rate of about 1¾ percent in the first half. CBO estimates that the unemployment rate will stay above 8%; however, inflation will remain relatively low.

With respect to healthcare spending, CBO analysts project that federal spending for mandatory health care programs (Medicare and Medicaid) will fall by $27 billion this year. The bulk of that reduction will be in Medicaid spending – which CBO estimates will be approximately $22 billion lower than they had previously estimated. This drop, will largely be because in 2012 states became responsible for a greater share of Medicaid expenses than had been the case in recent years.

Between 2009 and 2011, the federal government temporarily boosted the percentage of Medicaid costs being covered by Washington as mandated by the Patient Protection and Affordable Care Act. That boost expired in 2012.

Also according to CBO, due to a technical accounting accommodation, spending for Medicare in 2012 is anticipated to be lower than it was in 2011. Most of that reduction (about $9 billion) is the result of 2012 payments being made in fiscal year 2011 because the first day of fiscal year 2012 (October 1, 2011) fell on a weekend. The federal fiscal year runs from October 1 – September 30.

Were it not for this calendar adjustment, Medicare outlays would be up by nearly 4 percent this year compared to 2011.

Medicare and Medicaid – the two largest federal health care programs – account for most of the increase in projected federal spending for so-called entitlement programs over the next 10 years. Under current law, payment rates for most services in the fee-for-service sector of Medicare (i.e. hospital care and physician services, home health services, etc.) are subject to automatic updates.

Those automatic updates are linked to changes in certain market basket prices for things such as labor, goods, and services that health care providers purchase. These figures are then adjusted downward to account for gains in economy-wide productivity.

CBO’s productivity projections are lower than they were in a previous forecast, and its projected prices for goods and services are now higher. Consequently, CBO now anticipates higher payment rates for Medicare than it forecast in March. If CBO is right, this would raise projected Medicare outlays by $136 billion (or about 2 percent) over the 2013–2022 period. In the Medicaid program, higher projected prices for medical services and the cost of labor are also expected to boost spending, by $27 billion, between 2013 and 2022.

If CBO’s projections hold, it is possible that the SGR related cut slated to take effect on January 1, 2013 could be less than previously thought. Currently, the SGR related cut is expected to be approximately 27%. This is the amount necessary to put Medicare spending in line with the budget targets set last year. The 27% cut announced in July was before the latest spending projections were released by CBO. While the SGR related cut would still be substantial, it may be significantly lower.

This would also mean that the “cost” of fixing the SGR formula would also be less than previously estimated. While there has been broad bi-partisan consensus within Congress on the need to “repeal and replace” the SGR formula, Congress has been unable to come up with a way to “pay for” a more provider-friendly formula.

These new budget projections may make that job a bit easier. Stay Tuned!

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ONC/CMS Announce Stage II Meaningful Use Criteria

On August 23, CMS published the final rule for Stage II Meaningful Use criteria for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. The rule provides new criteria that eligible professionals (EPs) must meet in order to successfully participate in the EHR Incentive Programs.

CMS recently updated the EHR Incentive Programs website with a new Stage II section, which provides helpful information on the new criteria and how these will affect the EHR Incentive Program. The Stage II page includes an overview of the final rule and links to resources:

• Stage II Overview Tipsheet – Provides an overview of the rule, including important dates, basic requirements, new audiences, and additional Stage II resources.

• Stage I vs. Stage II Comparison Tables – Compares basic requirements of Stage I versus Stage II for EPs.

• Stage I Changes Tipsheet – This document outlines major changes to Stage I included in the rule.

• Payment Adjustments & Hardship Exceptions Tipsheets – Details the schedule and percentages of the payment adjustments, as well as information about hardship exemptions for EPs.

• 2014 Clinical Quality Measures Tipsheet – An overview of the 2014 CQM requirements that will apply to all providers, regardless of their stage of meaningful use.

According to a press release issued by the agency, CMS will continue to provide resources for providers on Stage II rule and the EHR Incentive Programs. Visit the Stage II page to learn more about upcoming CMS/ONC sponsored webinars and sessions discussing Stage II and the different changes occurring.

 

If you would like more information about the EHR Incentive Programs, you are encouraged to visit the EHR Incentive Programs website for the latest news and updates.

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CMS Announces Improvements to PECOS

Over the last year, CMS staff have been meeting regularly with industry stakeholders, including HBMA, to solicit feedback and suggestions for improving the Internet-based PECOS (Provider Enrollment Chain of Ownership System). Based upon that feedback, CMS has made improvements, particularly making PECOS easier to use. The following upgrades are now available:

▪ Providers/suppliers can now submit their entire enrollment application including supporting documentation electronically with the new digital document feature. Providers/suppliers are no longer required to physically mail copies of their supporting documentation to the Medicare Administrative Contractors (MACs). Please refer to the “Digital Documents Repository How to Guide” on the CMS website.

▪ Individual providers that reassign benefits to Individuals/Organizations with multiple practice locations are able to designate a primary and secondary practice location where services are rendered. Selecting a primary and secondary practice location does not restrict the provider from providing services at other practice locations associated with the Individual/Organization to which they are reassigning benefits. It is recommended that a primary and secondary practice location be specified, but it is not required.  

▪ Providers/suppliers will now be able to enter multiple contact persons in the Contact Information section (such as a billing company) and will have the ability to identify the contact’s relationship to the Provider/Supplier. While Internet-based PECOS requires at least one contact person to be entered in this section, additional contacts and the relationship to the provider field are optional.

▪ At least one managing employee will now be required when submitting a 855A, 855B and 855S enrollment application. Applications that do not include at least one managing employee will receive an error message in Internet-based PECOS under the Error/Warning Check tab and will not be able to proceed with submitting the enrollment application. Internet-based PECOS will also recommend that at least one owner is entered for a 855A, 855B and 855S application.

Applications that do not include at least one owner will receive a warning message under the Error/Warning Check tab in Internet-based PECOS, however, this warning message will not prevent the user from submitting the enrollment application.

▪ Providers/suppliers now have the option of selecting “County” in the “Geographic Location” topic when identifying the Geographic Location where services are rendered for 855A and 855B enrollment applications. Prior to this feature the only available options were State, City, or Zip Code. When selected, Internet-based PECOS will populate the county field with all counties that exist within the enrollment state identified for the application.   

▪ The CMS 855O paper application, used to enroll in Medicare solely to order and refer services, has been redesigned and the changes are reflected in Internet-based PECOS. As a reminder, providers that are currently enrolled in Medicare and are of a specialty that is eligible to order and refer, already have the ability to order and refer services and therefore are not required to submit a separate CMS 855O enrollment application solely to order and refer services. 

To access internet-based PECOS, go to the PECOS website.

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HHS Announces New ICD-10 Compliance Date

Due to on-going delays in preparing for ICD-10 implementation, the Department of Health and Human Services announced earlier this year that they intended to change the effective date from October 1, 2013 to some later, unspecified date. The Department sought industry feedback on the value of a delay and also suggestions on what the new date should be. In announcing her intention to delay the effective date, the Secretary suggested October 1, 2014 as a possible new effective date but solicited industry input on the practicality and feasibility of delaying the effective date for one year.

In comments submitted in response to the Secretary’s call for feedback, HBMA indicated that the organization would support a one year delay – October 1, 2013 to October 1, 2014.

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HHS Announces New Rules for Health Plan Identifiers (HPID) and “Other Entity” Identifiers (OEID)

In the same Rule in which Secretary Sebelius announced the new effective date for adoption and use of ICD-10, the Secretary announced new requirements for obtaining and using Health Plan IDs (HPID) and “Other Entity IDs (OEID).

According to HHS Secretary Kathleen Sebelius, “These new standards are a part of our efforts to help providers and health plans spend less time filling out paperwork and more time seeing their patients.” Currently, when a health care provider bills a health plan, that plan may use a wide range of different identifiers that do not have a standard format.

The Health Insurance Portability and Accountability Act (HIPAA), enacted in 1996, mandated that the Department establish both unique provider identifiers and health plan identifiers. Since 2007, all health plans have been required to accept the federally issued National Provider Identifiers (NPIs) as the basis for healthcare transactions. Although the HIPAA law also mandated the creation and use of standard Health Plan Identifiers, the Department had never issued any standards – until now.

According to the Final Rule, Health plans, excluding small health plans, are required to obtain HPIDs by November 5, 2014. Small health plans are required to obtain HPIDs by November 5, 2015.  All covered entities must use HPIDs in the standard transactions on or after November 7, 2016.

These new rules also establish a “data element” that will serve as an “other entity” identifier (OEID), or an identifier for entities that are not health plans, health care providers, or individuals, but that need to be identified in standard transactions. A billing company would be an entity that would be able to obtain and use an OEID.

Under this final rule, other entities are not required to obtain an OEID, but they could obtain and use one if they need to be identified in covered transactions. Because other entities are identified in standard transactions in a similar manner as health plans, CMS believes that establishing an identifier for other entities will increase efficiency by facilitating the use of a uniform identifier.

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NPI Database: GAO raises identity theft concerns

The Government Accountability Office (GAO) has been reaching out to various healthcare professional organizations, as well as organizations that work with physicians, to discuss concerns about the type of information available on the National Plan and Provider Enumeration System (aka NPI database).

 

It appears that GAO has recently been made aware of the fact that many physicians have voluntarily entered personal information into the public section of the NPI database without realizing the information was accessible by anyone. Some physicians have posted their tax ID numbers, DEA numbers, work and home addresses and other personal information that would allow an unscrupulous individual to credibly present him or herself as that physician.

GAO is assessing whether it would be feasible to impose restrictions on who can access the NPPES database.

In discussing this problem with physician organizations, it has become apparent that some physicians mistakenly believe that all of the information they posted in the NPI database is password protected. This is not the case. Only the information posted in the password protected section of the database is private. HBMA members are encouraged to communicate with their physician clients to ensure that only the minimal amount of information necessary is available on the public portions of the NPI database. Information your provider clients would like to keep private should be removed from the public sections of the NPI database and reentered in the password protected area of the website.

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RAC Denials on the Rise

According to the American Hospital Association, the number of RAC related denials was up 24 percent from the 2nd quarter of 2012, compared to the 1st quarter of 2012. According to RAC-Trac, an on-line data reporting site maintained by the American Hospital Association

• RAC Medical record requests are up 22% relative to the 1st quarter of 2012.

• The number of denials is up 24% relative to 1st quarter of 2012.

• The dollar value of denials is up 21% relative to the 1st quarter of 2012.

• Nearly two-thirds of medical records reviewed by RACs did not contain an improper payment.

• 84% of hospitals indicated medical necessity denials were the most costly complex denials.

• More than two-thirds of medical necessity denials reported were for 1-day stays where the care was found to have been provided in the wrong setting, not because the care was not medically necessary.

More than 2,000 hospitals nationwide have participated in the AHA initiative and reported data on the website. The RAC-Trac summary report is available on-line for review.

Hospitals are still reporting a high success rate appealing RAC denials or recoupments. It is worth nothing that according to RAC-Trac, 40 percent of hospitals are appealing adverse rulings, and 75 percent are winning their appeals.

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It’s Not Too Late to Sign-Up for PQRS bonus payments

CMS would like to remind providers that it is not too late to participate in the 2012 Physician Quality Reporting System (PQRS) and potentially qualify to receive an incentive payment equal to 0.5% of an eligible professional’s total Medicare Part B allowed charges for services furnished during the reporting period. A new six month reporting period using the registry submission option began on July 1, 2012. In addition, there are still ways to participate in the 12-month reporting period using claims, registry, or Electronic Health Record (EHR) submission.

The 2012 PQRS has two reporting periods:  12 months (January 1 through December 31, 2012); and, 6 months (July 1 through December 31, 2012). Providers can use one of the following options to report PQRS data for services furnished January 1 through December 31, 2012:

▪ EHR-based reporting (Direct EHR or Data Submission Vendor) of at least three PQRS measures for 80% or more of the applicable Medicare Part B FFs patients

▪ EHR-based reporting (Alignment with Medicare EHR Incentive Program) of all three Medicare EHR Incentive Program core measures OR up to 3 Medicare EHR Incentive Program alternate core measures AND 3 additional measures for the Medicare EHR Incentive Program

▪ Registry-based reporting of at least three PQRS measures for 80% or more of the applicable Medicare Part B FFS patients

▪ Registry-based reporting of at least one measures group for 30 or more applicable Medicare Part B FFS patients

▪ Registry-based reporting of at least one measures group for 80% or more of applicable Medicare Part B FFS patients (with a minimum of 15 patients)

▪ Claims-based reporting of at least one measures group for 30 or more applicable Medicare Part B FFS patients

To report PQRS data for services furnished July 1 through December 31, 2012 use the following option:

* Registry-based reporting of one measures group for 80% or more of applicable Medicare Part B FFS patients (with a minimum of 8 patients)

Eligible professionals do not need to sign up or pre-register to participate in the 2012 PQRS.  Submission of the appropriate quality data codes (QDCs) for individual measures or for a measures group on Part B claims will indicate intent to participate.  Eligible professionals who intend to participate via registry or EHR mechanisms should work with their registry or EHR vendor on transmitting their 2012 PQRS measure data to CMS in early 2013.

Although there is no requirement to register prior to submitting the data, CMS points out that “there are some preparatory steps that eligible professionals should take prior to undertaking PQRS reporting.” 

If you or your physician clients would like to access the PQRS educational resources, CMS recommends you to visit the PQRS website.  

CMS also asks that you make your physician clients aware of the fact that eligible professionals should note that 2012 is the last reporting year tied exclusively to an incentive payment.  Beginning in 2015, CMS will apply a negative payment adjustment (i.e. payment reduction) to eligible professionals who do not satisfactorily report data on quality measures for covered professional services.

Reporting during the 2013 PQRS program year will be used to determine whether a PQRS payment adjustment applies in 2015. The proposed criteria for satisfactorily reporting data on quality measures to avoid the 2015 PQRS payment adjustment is detailed in the 2013 Medicare Physician Fee Schedule Proposed Rule, which was published on July 30, 2012.

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CMS Transmittals

The following Transmittals were released by CMS during the month of August.

|Transmittal Number |Subject | |Effective Date |

|R10QRI |Physician Quality Reporting System and Electronic Prescribing (eRx) Incentive Program Pub. 100-22 |2012-10-29 |

| |Medicare Quality reporting Incentive Programs Manual Update | |

|R82SOMA |CMS Certification Numbers for Medicaid-Only Hospitals and New State Code for Foreign Countries. |2012-08-01 |

|R1102OTN |Direction to Modify Institutional Reason Code 39012 |2013-01-07 |

|R1103OTN |Health Insurance Portability and Accountability Act (HIPPA) 5010 and D.0 Executive of the Annual |2012-09-04 |

| |Recertification Program. | |

|R2508CP |Claim Status Category and Claim Status Codes Update |2012-10-01 |

|R2507CP |Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Pricer Update FY 2013|2012-10-01 |

|R1106OTN |Posting the Limiting Charge after Applying the e-Prescribing (eRx) Negative Adjustment |2013-01-07 |

|R1107OTN |The Medicare Secondary Payer Payment Module (MSPPAY) to be Maintained by the Shared System |2013-01-07 |

| |Maintainers for all Future Enhancements | |

|R1108OTN |Fee For Service Common Eligibility Services (FFS CES) - Common Working File (CWF) Detail Analysis, |2013-01-07 |

| |Design and Requirements | |

|R87MSP |Clarification of Medicare Conditional Payment Policy and Billing Procedures for Liability, No-Fault |  N/A |

| |and Workers’ Compensation Medicare Secondary Payer (MSP) Claims. | |

|R2510CP |Payment of Global Surgical Split Care in a Method II Critical Access Hospital (CAH) Submitted with |2013-01-07 |

| |Modifier 54 and/or 55 | |

|R2514CP |October 2012 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to |2012-10-01 |

| |Prior Quarterly Pricing Files | |

|R144NCD |Transcutaneous Electrical Nerve Stimulation (TENS) for Chronic Low Back Pain (CLBP) |2013-01-07 |

|R2511CP |Transcutaneous Electrical Nerve Stimulation (TENS) for Chronic Low Back Pain (CLBP) |2013-01-07 |

|R145NCD |National Coverage Determination (NCD) for Transcatheter Aortic Valve Replacement (TAVR) |2013-01-07 |

|R146NCD |Liver Transplantation for Patients with Malignancies |2012-09-04 |

|R2512CP |National Coverage Determination (NCD) for Transcatheter Aortic Valve Replacement (TAVR) |2013-01-07 |

|R2513CP |Liver Transplantation for Patients with Malignancies |2012-09-04 |

|R2506CP |Extracorporeal Photopheresis (ICD-10) |2012-10-01 |

|R1110OTN |Revision of Medicare Summary Notice (MSN) for Non- Competitive Bid Claims |2012-07-02 |

|R1111OTN |Expand Place of Service Address to Include Full Address |2013-04-01 |

|R2515CP |Handling Form CMS-1500 Hard Copy Claims Where an ICD-9-CM "E" Code or Where an ICD-10 V00-Y99 Code is|  N/A |

| |Reported as the First Diagnosis on the Claim | |

|2516 |New Non-Physician Specialty Code for Centralized Flu. |2013-01-07 |

|R212FM |New Non-Physician Sppeciality Code for Centralized Flu. |2013-01-07 |

|R1112OTN |Health Insurance Portability and Accountability Act (HIPAA) 5010 837 Institutional (837I) Edits and |2013-01-07 |

| |5010 837 Professional (837P) Edits January 2013 | |

|R2517CP |Medicare Claims Processing Pub. 100-04 Chapter 24 Update for Security Requirements. |2012-09-10 |

|R2518CP |Inpatient Rehabilitation Facility (IRF) Annual Update: Prospective Payment System (PPS) Pricer |2012-10-01 |

| |Changes for FY 2013. | |

|R2519CP |New Fiscal Intermediary Shared System (FISS) Consistency Edit to Validate Attending Physician NPI. |2013-01-07 |

|R2520CP |Update-Inpatien Psychiatric Facilities Prospective Payment System (IPF PPS) Fiscal Year (FY) 2013. |2012-10-01 |

|R1114OTN |New Field Established within FISS and MCS |2013-01-07 |

|R84DEMO |Revisions to the Method of Cost Settlement for Inpatient Services for Rural Hospitals Participating |2012-09-18 |

| |Under Demostration Authorized by Section 410A of the Medicare Modernization Act. Sections 3123 and | |

| |10313 of the Affordable Care Act authorizes and expansion of the demostration and an extension for an| |

| |additional 5-year period. This CR makes revisions fo CR 7505, which gives instructions for the | |

| |additional 5-year period. | |

|R88MSP |Expanding the Coordination of Benefits (COB) Contractor Numbers to Include 11139 and 11142 for the |2012-08-17 |

| |Common Working File (CWF). | |

|R2521CP |Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), and Medicare Remit Easy |2012-10-01 |

| |Print (MREP) and PC Print Update. | |

|R2525CP |October 2012 Update of the Ambulatory Surgical Center Payment System (ASC) |2012-10-01 |

|R2531CP |October 2012 Update of the Hospital Outpatient Prospective Payment System (OPPS) |2012-10-01 |

|R2526CP |2013 Annual Update for the Health Professional Shortage Area (HPSA) Bonus Payments |2013-01-07 |

|R2530CP |October Update to the CY 2012 Medicare Physician Fee Schedule Database (MPFSDB) |2012-10-01 |

|R1116OTN |Standardizing the Standard - Phase I |  N/A |

|R79GI |January 2013 Quarterly Updates to the CMS Standard File for Reason Codes for the Fiscal Intermediary |2013-01-07 |

| |Shared System (FISS) | |

|R2529CP |2013 Healthcare Common Procedure Coding System (HCPCS) Annual Update Reminder |2013-01-07 |

|R2528CP |Instructions for Downloading the Medicare ZIP Code File for January 2013 |2013-01-07 |

|R2523CP |Revised Medicare Summary Notice (MSN) Message Regarding Outpatient Therapy Caps |2012-10-01 |

|R1115OTN |Implement Fraud Prevention Predictive Modeling Prepayment Edits for Shared Systems (xref CR7787) |  N/A |

|R89MSP |Expanding the Coordination of Benefits (COB) Contractor Numbers to include 11139 and 11142 for the |2013-01-07 |

| |Common Working File (CWF) | |

|R2534CP |Healthcare Provider Taxonomy Codes (HPTC) Update, October 2012 |2013-01-07 |

|R2535CP |Update to Remove Outdated Information |2012-10-01 |

|R2537CP |Expiration of 2012 Therapy Cap Revisions and User-Controlled Mechanism to Identify Legislative |2013-01-07 |

| |Effective Dates | |

|R2539CP |Fiscal Year (FY) 2013 Inpatient Prospective Payment System (IPPS), Long Term Care Hospital |2012-10-01 |

|R1117OTN |Manual Medical Review of Therapy Services |2012-10-01 |

|R2536CP |Indian Health Services (IHS) Hospital Payment Rates for Calendar Year 2012 |2012-10-01 |

|R431PI |Ordering and Certifying Documentation - Maintenance Requirements |2012-10-01 |

|R432PI |Timeframe for Handling OIG Hotline Complaints Uploaded into the OIG Hotline Database; Requirements |2012-08-01 |

| |for the Transfer and Closing of Cases in the OIG Hotline Complaint Database System | |

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