This week in Medicare—12/6/2023
Correction Notice: Medicare Secondary Payer and Certain Civil Money Penalties Final Rule
On November 27, CMS published a Correction Notice in the Federal Register regarding the Medicare Secondary Payer and Certain Civil Money Penalties Final Rule, which was published on October 11. The corrections apply to an error in the Words of Issuance, technical errors in amendatory instructions, and minor errors in the table on page 70373.
Effective date: This correcting document is effective December 11.
The Risk of Misuse and Diversion of Buprenorphine for Opioid Use Disorder in Medicare Part D
On November 27, the OIG published a Data Brief regarding the risk of misuse and diversion of buprenorphine in Medicare Part D in 2022. The data brief showed that in 2022, almost all Part D enrollees who received buprenorphine for the treatment of opioid use disorder received the recommended amounts. Most enrollees received buprenorphine-naloxone combination products, which generally minimize the risk of misuse or diversion. These results are similar to findings from 2021 and suggest the risk of misuse or diversion of this drug continues to be low. The OIG said these findings indicate CMS should consider developing future Department guidelines related to buprenorphine prescribing, and that this treatment could be a key tool in confronting the opioid epidemic.
Part B Payment Amount for Tezspire Included a Noncovered Self-Administered Version in 2023
On November 28, the OIG published enrollee years. It also stated that the OIG “improperly implied” that Medicare Advantage organizations are expected to assure that 100% of the diagnosis codes received from providers and submitted to CMS are accurate. The OIG reduced the number of enrollee years in error from 222 down to 220. It also stated that while MA organizations are held under a “good faith attestation” standard under CMS rather than 100% medical record support, the OIG noted that MA organizations are still responsible for having compliance programs and that because the audit found a significant number of errors, SelectCare should identify similar instances of noncompliance.
Hospice Benefit Policy Manual Updates Related to the Addition of Marriage and Family Therapists (MFT) or Mental Health Counselors (MHC) to Hospice Interdisciplinary Team
On November 30, CMS published Medicare Benefit Policy Transmittal 12385 regarding updates to the manual to include MFTs or MHCs in the hospice interdisciplinary group as finalized via the CY 2024 Physician Fee Schedule final rule.
Effective date: January 1, 2024
Implementation date: January 2, 2024
April 2024 Update to the MS-DRG Grouper and Medicare Code Editor (MCE) Version 41.1
On November 30, CMS published Medicare Claims Processing Transmittal 12384 regarding instructions to the contractors to update the MS-DRG Grouper and MCE to Version 41.1 for the April 2024 update.
Effective date: April 1, 2024
Implementation date: April 1, 2024
CY 2024 Annual Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge Payment
On November 30, CMS published Medicare Claims Processing Transmittal 12389 regarding the annual update for the CLFS, mapping for new codes for clinical laboratory tests, and updates for laboratory costs subject to the reasonable charge payment. It also discusses the most recent delay in the reporting period for clinical diagnostic laboratory tests.
CMS published MLN Matters 13467 on the same date to accompany the transmittal.
Effective date: January 1, 2024
Implementation date: January 2, 2024
Making Care Primary (MCP) Model Implementation
On November 30, CMS published Demonstrations Transmittal 12390 regarding the implementation of the MCP model. This model tests whether implementing new payment methodology and care delivery goals can reduce program expenditures and improve outcomes on key measures. The transmittal discusses the new ambulatory care management (ACM) code and MCP e-Consult Code (MEC), how to bill those codes, and more.
Effective date: July 1, 2024
Implementation date: April 1, 2024 – Analysis, Design, and Coding; July 1, 2024 – Complete Coding, Testing, and Implementation; October 1, 2024 – Implementation of BR 13392.12.4 for CWF only
Fall 2023 Semiannual Report to Congress
On December 1, the OIG published the Fall 2023 Semiannual Report to Congress. This report details the OIG’s work from April 1 – September 30, 2023, and it highlights over $3.44 billion in expected recoveries from OIG audits and investigations.
The OIG published a Press Release announcing the report on the same date.