This week in Medicare—5/29/2024
HHS Did Not Fully Comply With The Payment Integrity Information Act of 2019 and Applicable Improper Payment Guidance for FY 2023
On May 20, the OIG published a Report regarding HHS’ compliance with the Payment Integrity Information Act of 2019 and other related improper payment guidance. The report covers a variety of departments under HHS. The highlighted areas of noncompliance related to the Medicare program include:
- HHS did not effectively demonstrate improvements to payment integrity for the Medicare Part C program
- HHS’ Sampling and Estimation Methodology Plan (S&EMP) did not completely measure all key characteristics of a COVID-19 claims reimbursement program from testing, treatment, and vaccine administration
- Recovery audit activities for the identified improper payments for the Medicare Advantage program were delayed or missing cost-effectiveness documentation
Biden-Harris Administration Opens New Method For Launching EMTALA Complaints
On May 21, CMS published a Press Release to announce a new method on the CMS.gov website to allow individuals to file Emergency Medical Treatment and Labor Act (EMTALA) complaints by filling out an online form. The press release also links to the EMTALA webpage as a resource for patients to learn about what their rights are under EMTALA.
NCD 200.3 – Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer’s Disease
On May 23, CMS published Medicare Claims Processing Transmittal 12649 regarding the implementation of NCD 200.3, which went into effect April 7, 2022. While CMS has issued previous transmittals regarding the implementation of this NCD, this transmittal updates the Claims Processing Manual with coding information, claims processing instructions, contractor messaging about rejected claims, and more.
CMS published MLN Matters 13598 on the same date to accompany the transmittal.
Effective date: April 7, 2022
Implementation date: June 24, 2024
HCPCS Codes Subject to and Excluded From CLIA Edits
On May 23, CMS published Medicare Claims Processing Transmittal 12653 regarding the 2024 updates to HCPCS codes subject to and excluded from CLIA edits.
CMS published MLN Matters 13620 on the same date to accompany the transmittal.
Effective date: October 1, 2024
Implementation date: October 7, 2024
Quarterly Update to Home Health Grouper
On May 23, CMS published Medicare Claims Processing Transmittal 12654 regarding the regular October 2024 update to the home health grouper software.
Effective date: October 1, 2024
Implementation date: October 7, 2024
Update to July 2024 HCPCS File
On May 23, CMS published an updated Download Link for the July 2024 quarterly update to the HCPCS file.
Quarterly Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge Payment
On May 24, CMS published Medicare Claims Processing Transmittal 12657, which rescinds and replaces Transmittal 12606, to add business requirement 13613.3 and 13613.4.
CMS revised MLN Matters 13613 on the same date to accompany the transmittal.
Effective date: July 1, 2024
Implementation date: July 1, 2024