This week in Medicare—1/10/24
January 2024 Update of the Ambulatory Surgical Center (ASC) Payment System
On January 2, CMS published Medicare Claims Processing Transmittal 12439, which rescinds and replaces Transmittal 12420, dated December 21, 2023, to correct the ASC payment indicator for C9734 in table 7, delete HCPCS J1246 in table 8, add HCPCS codes A9601 and J2690 to table 8, add HCPCS A2025 to table 10, add conforming changes to the associated policy sections, correct a date error in BR 13481.9.1, and more. The original transmittal was issued regarding the January 2024 updates to the ASC payment system.
CMS revised MLN Matters 13841 to accompany the transmittal.
Effective date: January 1, 2024
Implementation date: January 2, 2024
Organizational Provider Enrollment Revalidation
On January 2, CMS published a Medicare Revalidation List data set to show which organizational providers need to revalidate enrollment records. CMS said it posts revalidation due dates 6–7 months in advance but will be sure to establish dates at least 90 days in advance. A due date of “TBD” means that CMS hasn’t set a due date and those providers do not need to take action.
ICD-10 and Other Coding Revisions to National Coverage Determinations (NCD)—April 2024 Update
On January 3, CMS published One-Time Notification Transmittal 12441 (1 of 2), which rescinds and replaces Transmittal 12318, dated October 19, 2023, to add FISS to BR 13390.11 and add clarifying verbiage to BR 13390.12. The original transmittal was issued regarding the quarterly updates to ICD-10 coding conversions and other coding updates specific to NCDs. Affected NCDs include NCD 20.4 (Implantable Cardiac Defibrillators), NCD 20.9.1 (Ventricular Assist Devices), NCD 20.16 (Cardiac Output Monitoring by Thoracic Electrical Bioimpedance (TEB), and more.
CMS revised MLN Matters 13390 to accompany the transmittal.
Effective date: April 1, 2024
Implementation date: November 21, 2023 – Requirements 2, 4, 11 (except FISS); April 1, 2024 – unless otherwise indicated in individual business requirements
On January 3, CMS published One-Time Notification Transmittal 12440 (2 of 2), which rescinds and replaces Transmittal 12350, dated November 3, 2023, to make changes to NCD 90.2, NGS, spreadsheet to align with revisions being made to CR 13278. The original transmittal was issued regarding the quarterly updates to ICD-10 coding conversions and other coding updates specific to NCDs. Affected NCDs include NCD 160.18 (Vagus Nerve Stimulation), NCD 160.24 (Deep Brain Stimulation), NCD 190.3 (Cytogenetic Studies), and more.
CMS revised MLN Matters 13391 to accompany the transmittal.
Effective date: April 1, 2024 – unless otherwise indicated in individual business requirements
Implementation date: November 21, 2023 – BRs 2, 6, 7, 12 – MACs; January 2, 2024 – BR 11; April 1, 2024 – unless otherwise indicated in individual business requirements
April 2024 ICD-10-CM Update Files
On January 3, the CDC published updated Files for the ICD-10-CM code set. These updates contain April 2024 changes to codes as listed in the addenda files, code description file, and ICD-10-CM table and index.
Advisory Opinion No. 23-12
On January 3, the OIG published an Advisory Opinion regarding an arrangement in which physician partners who hold direct partnership interests in a limited liability partnership with the requestor would receive a one-time, voluntary redemption offer at age 67 to have their partnership units repurchased by the requestor over a two-year period contingent upon to physician partners’ agreement to retire from practicing medicine. Because the physician partners are engaged in a partnership agreement that permits the redemption of the physician’s stakes in the agreement upon retirement, the requestor is concerned that it could face a liquidity crisis if a large number of the physician partners retire in succession. The requestor is seeking an opinion as to whether the arrangement constitutes grounds for the imposition of sanctions under the federal anti-kickback statute.
The OIG determined that while the arrangement could potentially generate prohibited remuneration under the anti-kickback statute, it would not impose sanctions in this case because the redemption offer is made for a purpose unrelated to the volume or value of referrals that could potentially be generated under the arrangement. It also said the remuneration paid pursuant to the redemption offer agreement is unlikely to result in unfair competition.
Medigap-Related Advisory Opinions
On January 3, the OIG published Advisory Opinion 23-13 and Advisory Opinion 23-14 regarding the use of “preferred hospital” networks as part of Medigap policies. The requestors were looking to see if insurance companies could contract with a preferred hospital network to provide discounts on the otherwise applicable Medicare inpatient deductibles for policyholders and, in turn, the insurance company would provide a premium credit of $100 off the next renewal premium to policyholders who use a network hospital for an inpatient stay. The requestors were seeking opinions as to whether these arrangements would be grounds for the imposition of sanctions under the anti-kickback statute and beneficiary inducements civil monetary penalty.
In both cases, the OIG ruled favorably for the requestors and said that while the proposed arrangements would generate prohibited remuneration under the antikickback statute and beneficiary inducements civil monetary penalty, the OIG would not impose administrative sanctions in these cases because the arrangements would be unlikely to increase costs for federal healthcare programs, are unlikely to lead to inappropriate utilization of healthcare services, and would be unlikely to impact competition or patient choices.
Advisory Opinion No. 23-15
On January 3, the OIG published an Advisory Opinion regarding an arrangement in which a consulting firm offers current physician practice customers a $25 gift card for recommending their services to prospective clients, as well as an additional $50 gift card if the recommendation is successful. The consulting firm requested an opinion as to whether this would be grounds for the imposition of sanctions under the anti-kickback statute. The OIG said that this arrangement does not implicate the statute, as the consulting firm certified that it does not recommend to any customer the purchasing, leasing, or ordering of any item or service for which payment may be made in whole or in part under a federal healthcare program. The OIG therefore would not impose any sanctions in this case.
Updated List of Laboratory Tests Subject to Exceptions to Laboratory Date of Service Policy
On January 3, CMS published the Download Link to the updated list of laboratory tests subject to exceptions to the lab date of service policy.
Clinical Laboratory Fee Schedule – Medicare Travel Allowance Fees for Collection of Specimens and New Updates for 2024
On January 4, CMS published Medicare Claims Processing Transmittal 12443 regarding revisions to payment of travel allowances when billed on a per mileage basis as reported by HCPCS code P9603 or when billed on a flat rate basis as reported by HCPCS code P9604.
Effective date: January 1, 2024
Implementation date: February 7, 2024
Quarterly Update for the DMEPOS Competitive Bidding Program (CBP) – April 2024
On January 4, CMS published Medicare Claims Processing Transmittal 12442 regarding the regular quarterly instructions to the contractors for updating the DMEPOS CBP files.
Effective date: April 1, 2024
Implementation date: April 1, 2024
In-Home Vaccination Payment
On January 4, CMS updated its In-Home Vaccine Administration: Additional Payment webpage to add payment, coding, and eligibility information for the additional payment for in-home administration of flu, hepatitis B, and pneumococcal vaccines. This payment went into effect on January 1.
CMS also updated its COVID-19 Vaccine Shot Payment webpage on the same date to add information about CY 2024 payment for in-home administration. Medicare pays approximately $78 for this service in CY 2024.
National Fee Schedule for Medicare Part B Vaccine Administration CMS – January 2024
On January 5, CMS published Medicare Claims Processing Transmittal 12403, which rescinds and replaces Transmittal 12339, dated November 2, 2023, to include the revised file name in BR 13408.1.1 that was delivered on December 5, 2023. The original transmittal was published internally only and was issued regarding instructions to the contractors on downloading and implementing the annual Part B Preventive Vaccine Administration file.