This week in Medicare—1/31/2024

January 31, 2024
Medicare Insider

CMS Adds More Utilization Data to Doctor and Clinician Profiles on Care Compare Tool

On January 18, CMS updated its Care Compare Online Tool to include additional utilization data on the doctor and clinician profile pages.


CMS Announces New Actions to Help Hospitals Meet Obligations under the Emergency Medical Treatment and Labor Act (EMTALA)

On January 22, CMS published a Press Release to announce a series of actions aimed at educating the public on emergency medical care rights and helping hospitals meet EMTALA obligations.

CMS plans to publish additional resources on its website to help individuals understand their rights under EMTALA and the complaint submission process. The agency will also partner with hospital and provider associations to disseminate EMTALA training materials, discuss best practices, and identify compliance challenges.


Reopened Comment Period: Federal Independent Dispute Resolution Operations

On January 22, CMS published a Notice in the Federal Register to announce that it is reopening a comment period for the Federal Independent Dispute Resolution (IDR) Operations proposed rule, dated November 3, 2023, to allow more time for comments on how a recent final rule on the IDR fees (published December 21, 2023) may affect the proposals in the IDR operations proposed rule.

The new comment period is from January 22 – February 5.


Implementation of New Benefit Category for Lymphedema Compression Treatment Items

On January 24, CMS published Medicare Claims Processing Transmittal 12471, which rescinds and replaces Transmittal 12379, dated November 22, 2023, to revise BR 13286.5.1. CMS clarified that contractors are to use Group Code PR, Claim Adjustment Reason Code 96, Remittance Advice Remark Code N425, and Medicare Summary Notice message code 16.10. The original transmittal was issued regarding the implementation of a new benefit category for lymphedema compression treatment items. 

CMS revised MLN Matters 13286 to accompany the transmittal.

Effective date: January 1, 2024

Implementation date: January 2, 2024


Correct Billing for Opioid Use Disorder Treatment Services

On January 25, CMS updated a Webpage on billing for opioid treatment programs (OTP) to add G-code frequency of use guidelines for providers billing OTP G-codes. CMS noted that intake activity code G2076 should only be used to bill for new patients starting opioid use disorder treatment at an OTP for medically reasonable and necessary services.


Medicare Provider Enrollment

On January 25, CMS updated an MLN Educational Tool on Medicare provider enrollment to add recent changes to forms, specialty codes, and fee amounts. These changes include:

  • Update to enrollment application fee amount for 2024
  • Addition of marriage and family therapists, mental health counselors, and certain dental specialties to the Part B suppliers list
  • Merging Form CMS-855R into the CMS-855I paper enrollment application
  • Addition of new provider specialty code information for dentists

The changes in the text of the webpage are noted in red.


CMS Posts “Data to Drive Decision Making Cross-Cutting Initiative”

On January 25, CMS published a Fact Sheet on its six Data Principles recently developed by the Data to Drive Decision-Making Cross-Cutting Initiative. Those six principles are efficiency, accessibility, usability, quality, responsibility, and transparency. The fact sheet also details actions that CMS must take to achieve each principle.


Quarterly Update to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS)

On January 25, CMS published Medicare Claims Processing Transmittal 12474 regarding the quarterly updates to the ESRD PPS. The transmittal provides instructions for removing HCPCS code J0879 (injection, difelikefalin, 0.1 mcg) from the TDAPA code list. This code will now be processed as a covered line item and bundled into the PPS without separate payment.

Effective date: April 1, 2024

Implementation date: April 1, 2024


Payment for Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs) in a Method II Critical Access Hospital (CAH)

On January 25, CMS published Medicare Claims Processing Transmittal 12477 to establish payment instructions for MFTs and MHCs in a Method II CAH.

Providers billing services that were furnished in a Method II CAH on Type of Bill 85X have the option to reassign their billing rights to the CAH. When billing rights are reassigned to a Method II CAH, payment is made to the CAH for professional services. Medicare payment for MFTs and MHCs to a Method II CAH is 80% of the lesser of the actual charge for the services or 75% of the Medicare Physician Fee Schedule.

Effective date: January 1, 2024

Implementation date: February 26, 2024 - (for requirements implementation date)


Biden-Harris Administration Launches Effort to Increase Medicare Advantage (MA) Transparency

On January 25, CMS published a Press Release to announce a Request for Information (RFI) on enhancing MA data capabilities and increasing public transparency.

Comments on the RFI are due by May 29.


File Conversions Related to the Spanish Translation of HCPCS Descriptions

On January 25, CMS published Medicare Claims Processing Transmittal 12472 regarding directions to the contractors to implement the regular quarterly changes to the Spanish translations of HCPCS descriptions.

Effective date: April 1, 2024

Implementation date: April 1, 2024


Payment of M0010 Enhancing Oncology Model (EOM) Monthly Enhanced Oncology Services (MEOS) Claims for Beneficiaries Receiving Care in an Inpatient Setting

On January 25, CMS published Demonstrations Transmittal 12480 regarding instructions to the A/B MACs to issue payment for detail lines with M0010 with dates of service on or after July 1, 2023, irrespective of whether the beneficiary is receiving care in an inpatient or outpatient setting and provided that the MEOS billing meets all other conditions for payment. The change is the result of an issue where EOM participants were seeing denials for MEOS billing for beneficiaries during an inpatient or SNF stay.

Effective date: July 1, 2024

Implementation date: July 1, 2024 – Implementation of Business Requirements 13500.1 – 13500.2.1; October 28, 2024 – Implementation of Business Requirements 13500.3 and 13500.3.1; MACs to perform all mass adjustments of affected M0010 claims no later than October 28, 2024


340B Drug Lump-Sum Remedy Payments

On January 26, CMS updated the OPPS webpage to note that MACs have started to make the one-time lump-sum remedy payments for the difference between what they were paid for 340B-acquired drugs from CY 2018 through September 27, 2022, had the 340B drug payment policy at -22.5% ASP never existed. MACs began making remedy payments on January 8 via HIGLAS, and CMS said those remedy payments should be completed by February 7. All remedy payments are subject to the MACs’ standard accounting procedures, and therefore they may be combined with other payments released on the same date. This might cause the lump-sum payment amount to differ from what was published in Addendum AAA of the 2024 OPPS final rule.