This week in Medicare—3/20/2024
April 2024 HCPCS Quarterly Update
On March 7, CMS published a Download Link for the April 2024 quarterly update to the HCPCS files.
Correction Notice: Principles of Reasonable Cost Reimbursement; Payment for End-Stage Renal Disease Services; Prospectively Determined Payment Rates for Skilled Nursing Facilities; Payment for Acute Kidney Injury Dialysis
On March 11, CMS published a Correction Notice in the Federal Register to reinstate paragraphs (b)(3)(ii)(C)(4) through (7) in 42 CFR 413.404. The following reinstated paragraphs detail costs that may be used to develop the deceased donor standard acquisition charge:
- Costs of tissue typing services, including those furnished by independent laboratories
- Organ preservation and perfusion costs
- General routine and special care service costs (for example, intensive care unit or critical care unit service related to the donor)
- Operating room and other inpatient ancillary service costs
Marriage and Family Therapists (MFT) & Mental Health Counselors (MHC): Updated Enrollment FAQs
On March 11, CMS updated an FAQ regarding MFT and MHC enrollment. CMS clarified the supervision requirements for both provider types, which mental health professionals can enroll as MHCs, reassignment arrangements, the telehealth enrollment process, and opt-out requirements.
February 2024 Livanta Claims Review Advisor
On March 11, Livanta published the February 2024 edition of the Livanta Claims Review Advisor. This edition discusses second-year review findings for higher-weighted DRGs (HWDRG), which encompasses reviews completed from November 1, 2022 – October 31, 2023. Livanta found that 88% of HWDRG claims were approved for the HWDRG submitted and paid.
Change Healthcare/ Optum Payment Disruption (CHOPD) Accelerated and Advance Payments for Part A Providers and Part B Suppliers Frequently Asked Questions (FAQ)
On March 13, CMS published an FAQ on CHOPD accelerated and advance payments for Part A providers and Part B suppliers following the recent cyberattack on UnitedHealth Group’s subsidiary Change Healthcare. The fact sheet provides clarity on the application criteria, repayment process, and further action from CMS.
CMS reiterated that CHOPD payment is intended to cover up to 30 days of Medicare claims and providers/suppliers have 90 days to repay the payment. However, CMS said it is continuing to monitor the situation and will issue further guidance if necessary.
July 2024 Quarterly ASP Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
On March 14, CMS published Medicare Claims Processing Transmittal 12547 regarding the quarterly updates to the ASP and Not Otherwise Classified drug pricing filed for Part B drugs.
Effective date: July 1, 2024
Implementation date: July 1, 2024
Update Pub. 100-04, Medicare Claims Processing Manual, Chapter 12, Section 30.6.1.1 Concerning HCPCS Billing Codes and Chapter 12, Section 30.6.2 Concerning Advance Beneficiary Notice of Non-coverage (ABN) Requirements
On March 14, CMS published Medicare Claims Processing Transmittal 12546 regarding updates to billing code requirements for Annual Wellness Visit (AWV) services and additional ABN guidance.
CMS clarified that providers are not to bill for AWV services using CPT codes 99381-99397 and instead should be using HCPCS codes G0402, G0438, and G0439. The agency stated that, although it is not required, physicians are strongly encouraged to provide an ABN to beneficiaries when providing and billing for a preventive medicine service.
Effective date: May 15, 2024
Implementation date: May 15, 2024
Changes to Laboratory National Coverage Determination (NCD) Edit Software for July 2024
On March 14, CMS published Medicare Claims Processing Transmittal 12540 regarding the July 2024 quarterly release of the edits for clinical diagnostic laboratory services. The NCDs affected by the July 2024 changes include:
- NCD 190.18 – Serum Iron Studies
- NCD 190.21B – Glycated Hemoglobin/Glycated Protein
- NCD 190.31 – Prostate Specific Antigen
On March 18, CMS published MLN Matters 13554 to accompany the transmittal.
Effective date: July 1, 2024 – unless noted differently in requirements
Implementation date: July 1, 2024
Updated OIG Work Plan
On March 15, the OIG updated its Work Plan with the following new items:
- Assessing the Accuracy of Nursing Home Falls Reporting in MDS Assessments
- Medicare Inpatient Hospital Billing for Sepsis
- Effects of Vertical Integration on Medicare Part D
- Audit of Nursing Facility Drug Overdoses
- Audit of Diabetes Drugs Under Medicare Part D
Revisions to Home Health Agencies (HHA) – Appendix B of the State Operations Manual
On March 15, CMS published a Memorandum to state survey agency directors regarding updates to the State Operations Manual Appendix B containing guidance for surveyors for home health agencies. The memo contains updates resulting from the release of several rules from the last few years which amended the home health Conditions of Participation (CoP), and CMS made corresponding updates to survey protocols, interpretive guidance, and tags. The memo lists the specific changes and discusses the reorganization of certain survey training courses and HHA survey systems.
Effective date: Immediately. Please communicate to all appropriate staff within 30 days.
Update to Physician Fee Schedule (PFS) Conversion Factor Due to Consolidated Appropriations Act, 2024
On March 18, CMS published an Update on the PFS webpage to note that the Consolidated Appropriations Act, 2024 included a 2.93% update to the CY 2024 PFS conversion factor effective for dates of service from March 9 through December 31, 2024. This changes the conversion factor for those dates to $33.29. The conversion factor for dates of service from January 1 – March 8, 2024, was $32.74. CMS also released updated payment files for the PFS files, ambulatory surgical center fee schedule files, and anesthesia files to include this change.