Monthly Archives: June 2016

CMS Posts Draft Medicare Outpatient Observation Notice (MOON), Instructions, and a Supporting Statement

CMS has posted the draft Medicare Outpatient Observation Notice (MOON), Instructions, and a Supporting Statement.  The Medicare Outpatient Observation Notice (MOON) is a standardized notice developed to inform beneficiaries (including Medicare health plan enrollees) that they are an outpatient receiving observation services and are not an inpatient of the hospital or critical access hospital (CAH).  The MOON is mandated by the federal Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act), passed on August 6, 2015.  The NOTICE Act requires all hospitals and CAHs to provide written and oral notification under specified guidelines.  The MOON, its instructions, and implementing regulations were published in the Federal Register on April 27, 2016, as part of the FY 2017 Medicare hospital inpatient prospective payment systems (IPPS) proposed rule. They are available for public comment through June 17, 2016

GAO Study Concludes that Opportunities Remain to Improve Medicare Appeals Process

In a report requested by the Senate Finance Committee, the Government Accountability Office (GAO) has determined that opportunities still remain for HHS to improve the Medicare fee-for-service appeals process and to reduce the increased volume of appeals.  The GAO study concludes that (1) Absent more complete and consistent appeals data, HHS’s ability to monitor emerging trends in appeals is limited and is inconsistent with federal internal control standards and (2) HHS efforts do not address inefficiencies regarding the way appeals of certain repetitious claims are adjudicated, which is inconsistent with federal internal control standards.  Continue reading

CMS Policy Change Delay: Required Use of JW Modifier for Discarded Part B Drugs and Biologicals

CMS announced in the June 6th Hospital Open Door Forum call that the policy change announced in April, requiring the use of the JW modifier for discarded Part B drugs and biologicals, will be delayed to January 1, 2017.  Per the policy change, when processing claims for drugs and biologicals (except those provided under the Competitive Acquisition Program for Part B drugs and biologicals (CAP)), use of the modifier JW to identify unused drugs or biologicals from single use vials or single use packages that are appropriately discarded with be required. CMS will no longer allow contractors’ discretion to determine whether the JW modifier is required for claims with discarded drugs and biologicals.  Continue reading

QIOs to Re-Review All Denied Short-Stay Patient Status Claims

According to a CMS spokesperson, the temporary pause in short-stay status reviews that began on May 4, 2016 may stretch through the end of July. That information, along with the announcement that the BFCC-QIOs will re-review all short stay patient status claims that were denied under the QIO medical review process came during the June 6, 2016 Hospital/Quality Initiative Open Door Forum call. CMS has indicated that they temporarily paused short stay patient status reviews when they became aware of inconsistencies in the BFCC-QIOs’ application of the two-midnight policy. CMS is requiring the BFCC-QIOs to re-review all claims they denied in their medical review process since October 2015 to make sure medical review decisions and subsequent provider education are consistent with current policy. CMS has indicated that they are working with the BFCC-QIOs to improve quality, including through educational sessions on practical application of the two-midnight policy in order to improve standardization in the BFCC-QIOs’ review process. Continue reading