This week in Medicare—2/14/2024
CMS Posts Transcripts from 10 Patient-Focused Listening Sessions for the Medicare Drug Price Negotiation Program
On February 1, CMS published Transcripts from 10 patient-focused listening sessions on each of the 10 drugs selected for the Medicare Drug Price Negotiation Program. The listening sessions took place in early November 2023 and gave interested parties an opportunity to share input relevant to the drugs selected for the first round of negotiations.
Health Equity Services in the 2024 Physician Fee Schedule Final Rule
On February 6, CMS published a Booklet backdated to January 2024 regarding the various health equity services covered in the 2024 Physician Fee Schedule Final Rule. CMS discusses billing, coding, and documentation practices for caregiver training services, social determinants of health risk assessment, community health integration, and principal illness navigation.
CY 2024 Home Infusion Therapy (HIT) Payment Rates and Instructions for Retrieving the January 2024 HIT Services Payment Rates Through the CMS Mainframe Telecommunications System
On February 6, CMS published Medicare Claims Processing Transmittal 12504, which rescinds and replaces Transmittal 12406, dated December 13, 2023, to update the policy section to reflect the extension of the work GPCI floor through March 8, 2024, as authorized by Section 131 of the Further Additional Continuing Appropriations Act of 2024. The original transmittal was published regarding updates to HIT service payment rates, and it was previously rescinded and replaced in December 2023.
Effective date: January 1, 2024
Implementation date: January 2, 2024
Accrediting Organization Proposed Rule Fact Sheet
On February 8, CMS published a draft copy of a Proposed Rule regarding Accrediting Organizations (AO). The rule is aimed at strengthening AO oversight, reducing conflicts of interest, and increasing transparency. The changes in the rule would apply to all AOs except those that accredit clinical laboratories and noncertified suppliers.
Notable provisions in the proposed rule include the following:
- Holding AOs to the same standards as CMS’ State Survey Agencies
- Placing certain limitations on the fee-based consulting services that AOs provide to the facilities they accredit
- Requiring AOs to report specific information on how they will monitor, prevent, and handle conflicts of interest
- Requiring poor-performing AOs to submit a publicly reported correction plan to CMS
The rule is scheduled to be published in the Federal Register on February 15, and comments are due by April 15. CMS published a Fact Sheet to accompany the rule.
Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) – April 2024 Update
On February 8, CMS published Medicare Claims Processing Transmittal 12501 regarding the quarterly updates to the MPFSDB files for the April 2024 quarter. The file is available for download from the CMS mainframe on February 16.
Effective date: January 1, 2024
Implementation date: April 1, 2024
Texting of Patient Information and Orders for Hospitals and CAHs
On February 8, CMS published a Memorandum to state survey agency directors regarding texting patient information and patient orders. CMS said it recognizes that texting has become an essential way for hospital and CAH staff to communicate and that there has been significant improvement in encryption and application interface capabilities between texting platforms and electronic health records. CMS is therefore amending guidance it published in 2018 to state that while computerized provider order entry (CPOE) continues to be the preferred method for communicating information, it will allow hospitals and CAHs to text orders via a secure, HIPAA-compliant platform into the patient’s medical record or electronic health record.
Effective date: Immediately. Please communicate to all appropriate staff within 30 days.
Manual Update for New Medicare Provider Specialty Codes (E1 and E2) and Payment for Marriage and Family Therapists and Mental Health Counselors
On February 8, CMS published Medicare Financial Management Transmittal 12238 to re-communicate the establishment of new provider specialty codes and payment instructions for Marriage and Family Therapists and Mental Health Counselors. The transmittal is no longer sensitive and may now be posted to the internet.
Effective date: January 1, 2024
Implementation date: October 2, 2023
Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print Update
On February 8, CMS published Medicare Claims Processing Transmittal 12498 regarding RARC, CARC, MREP, and PC Print updates.
Effective date: July 1, 2024
Implementation date: July 1, 2024
Pulmonary Rehabilitation, Cardiac Rehabilitation and Intensive Cardiac Rehabilitation (PR/CR/ICR) Expansion of Supervising Practitioners
On February 8, CMS published Medicare Claims Processing Transmittal 12497 and Medicare Benefit Policy Transmittal 12497 to alert MACs to updated Conditions of Coverage for PC/CR/ICR programs as established in the CY 2024 Physician Fee Schedule final rule.
CMS published MLN Matters 13513 to accompany the transmittals.
Effective date: January 1, 2024
Implementation date: March 12, 2024
Revisions to the Manual for the State Payment of Medicare Premiums
On February 9, CMS published State Payment of Medicare Premiums Transmittal 5 regarding updates to the manual to provide information and instructions to states on federal policy, operations, and systems involved in the payment of Parts A and B premiums for individuals dually eligible for Medicare and Medicaid. CMS updated the first chapter of the manual with information related to recent regulatory changes.
Effective date: February 9, 2024
Implementation date: February 9, 2024
Correction Notice: CY 2024 OPPS Final Rule
On February 9, CMS published a Correction Notice in the Federal Register regarding corrections to the CY 2024 OPPS Final Rule, which was published in the Federal Register on November 22, 2023. There were errors to calculations for the Hyperbaric Oxygen Therapy APC (APC 5061), errors involving the OPPS weight scalar, inadvertently omitted language regarding HCPCS codes used to report devices for heart monitors, and more.
Effective date: This correcting document is effective February 9, 2024.
Applicability date: This correcting document is applicable January 1, 2024.