This week in Medicare updates–09/06/17

Hurricane Harvey: CMS’ Response
Over the course of several days, CMS released several Press Releases related to Hurricane Harvey. On August 26, CMS announced that there were teams on the ground in Texas working with state and local officials to make sure beneficiaries had access to treatments.

On August 30, CMS said in a Press Release that it was taking actions which included the following:

• Temporarily waiving or modifying certain Medicare, Medicaid and Children’s Health Insurance Program (CHIP) requirements to provide immediate relief to those affected by the hurricane and resulting floods;
• Supporting Texas and Louisiana in arranging Special Purpose Renal Dialysis Facilities, transporting patients to facilities and arranging for new facilities to open in order to serve beneficiaries without interruption;
• Waiving three-day-prior hospitalization requirements for Skilled Nursing Facilities (SNF);
• Providing relief to Home Health Agencies on the timeframes related to completion of OASIS (assessment data) Transmission; and
• Waiving the requirements limiting the number of patient beds to 25, and allowing for length of stays beyond the capped 96-hour time period for Critical Access Hospitals (CAH).

On August 31, CMS issued another Press Release also focusing on efforts to address gaps in care for dialysis patients left vulnerable by Hurricane Harvey and its aftermath, including a short list of local resources for dialysis patients in Texas and Louisiana.

 

Tobacco Cessation Counseling Coverage Retired
On August 28, CMS announced the retirement of its smoking and tobacco-use cessation coverage on the Medicare coverage database. The coverage decision had been in place since 2005.

Effective date: September 30, 2015
Implementation date: September 26, 2017

 

Early Alert: The Centers for Medicare & Medicaid Services Has Inadequate Procedures To Ensure That Incidents of Potential Abuse or Neglect at Skilled Nursing Facilities (SNF) Are Identified and Reported in Accordance With Applicable Requirements
On August 28, the OIG published a memorandum alerting CMS to the preliminary results of an ongoing review of potential abuse or neglect of Medicare beneficiaries in SNFs. OIG identified 134 Medicare beneficiaries whose injuries may have been the result of potential abuse or neglect that occurred from January 1, 2015, through December 31, 2016. OIG found that a significant percentage of these incidents may not have been reported to law enforcement. As a result, we determined that CMS has inadequate procedures to ensure that incidents of potential abuse or neglect of Medicare beneficiaries residing in SNFs are identified and reported.

 

Accredo Health Group, Inc., Properly Billed Medicare for Inhalation Drugs
On August 29, the OIG published its finding that the Accredo Health Group, Inc., of Memphis, TN, complied with Medicare requirements when billing for inhalation drugs.

 

Fox Rehabilitation Claimed Unallowable Medicare Reimbursement for Outpatient Therapy Services
On August 29, the OIG published findings that Fox Rehabilitation of New Jersey, a large provider of outpatient therapy, claimed unallowable and medically unnecessary services. OIG recommends that Fox refund $29.9 million to the Federal Government and ensure that outpatient therapy services are provided and documented in accordance with Medicare requirements. Fox disagrees with OIG’s findings and recommendations.

 

October 2017 Update of the Hospital Outpatient Prospective Payment System (OPPS)
On August 29, CMS published MLN Matters 10236 which supplements Medicare Claims Processing Transmittal 3853, released August 25. The transmittal had updated billing, payment and coding policies for the OPPS for October 2017.  The update included:

• Information on the new benefit for Peripheral Artery Disease (PAD) Rehabilitation
• New proprietary lab codes
• Four new pass-through drugs
• Instructions for correct reporting of certain flu vaccines
• Clarification on coding and payment of blepharoplasty performed with blepharoptosis

Table with new codes and other information are attached.

Effective date: October 1, 2017
Implementation date: October 2, 2017

 

October 2017 Integrated Outpatient Code Editor (I/OCE) Specifications Version 18.3
On August 29, CMS published MLN Matters 10230, supplementing Medicare Claims Processing Transmittal 3852, which had been published August 25. This notification provides the table with the Summary of Quarterly Release Modifications and the Summary of Data Changes, with all new, deleted and revised codes.  These edits are used for claims processed under the Outpatient Prospective Payment System (OPPS) and Non-OPPS for hospital outpatient departments, community mental health centers, all non-OPPS providers, and for limited services when provided in a home health agency not under the Home Health Prospective Payment System or to a hospice patient for the treatment of a non-terminal illness. NOTE: the October quarterly update files have not been posted on the IOCE page at the time of publishing.

Effective date: October 1, 2017
Implementation date: October 2, 2017

 

Inpatient Rehabilitation Facility (IRF) Annual Update: Prospective Payment System (PPS) Pricer Changes for FY 2018
On August 29, CMS published MLN Matters 10125, supplementing Medicare Claims Processing Transmittal 3849, published August 25. This MLN Matters explores deeper the new IRF PRICER software package that will be released prior to October 1, 2017, and will contain the updated rates that are effective for claims with discharges that fall within October 1, 2017, through September 30, 2018.

Effective date: October 1, 2017
Implementation date: October 2, 2017

 

Comment Request: Critical Access Hospital (CAH) Conditions of Participation
On August 30, CMS published a Comment Request in the Federal Register about a data collection regarding conditions of participation for CAHs. Comments are due by September 29, 2017.

 

New Corporate Integrity Agreement
On August 30, the OIG published information on a new Corporate Integrity Agreement with Sightpath Medical, Inc., of Bloomington, MN. The agreement is effective August 10.

 

OIG Advisory Opinion: Use of "Preferred Hospital" Networks as Part of Medicare Supplemental Health Insurance ("Medigap") Policies
On August 31, the OIG published an Advisory Opinion. A healthcare organization wrote the OIG requesting an advisory opinion regarding use of preferred hospital networks as a part of Medicare Supplemental Health Insurance, or “Medigap” policies could constitute grounds for the imposition of sanctions under the Federal anti-kickback statute.

The OIG concluded that, although the Arrangement could potentially generate prohibited remuneration under the anti-kickback statute if the requisite intent to induce or reward referrals of Federal health care program business were present, the OIG will not impose administrative sanctions in connection with the arrangement.

 

Tropical Storm Harvey and Medicare Disaster Related Louisiana Claims
On August 31, CMS published MLN Matters 17021, a Special Edition Article intended for providers and suppliers who submit claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries in the State of Louisiana who were affected by Tropical Storm Harvey.

The MLN Matters was revised on September 1.

Effective date: N/A
Implementation date: N/A

 

Hurricane Harvey and Medicare Disaster Related Texas Claims
On August 31, CMS published MLN Matters 17020, a Special Edition Article intended for providers and suppliers who submit claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries in the State of Texas who were affected by Hurricane Harvey.

The MLN Matters was revised on September 1.

Effective date: N/A
Implementation date: N/A

 

Clarification of the Billing of Immunosuppressive Drugs
On September 1, CMS published CMS Medicare Claims Processing Transmittal 3856, which updates the manual to remove a double negative statement in order to provide clear instruction on the billing of immunosuppressive drugs.

Effective date: October 2, 2017
Implementation dates:  October 2, 2017

 

Internet Only Manual (IOM) Update to Pub. 100-04, Chapter 15 - Ambulance, to Restore Multiple Patients on One Trip Instructions
On September 1, CMS published CMS Medicare Claims Processing Transmittal 3855, which restores the "Multiple Patients on One Trip" instructions to Pub. 100-04, Chapter 15 - Ambulance, Section 30.1.2

Effective date: October 2, 2017
Implementation dates:  October 2, 2017

 

October 2017 Update of the Ambulatory Surgical Center (ASC) Payment System
On September 1, CMS published CMS Medicare Claims Processing Transmittal 3854, with updates to the ASC payment system, payment rates for separately payable drugs and biologicals, including descriptors for newly created Level II Healthcare Common Procedure Coding System (HCPCS) codes for drugs and biologicals (ASC DRUG files), the ASC PI file, the calendar year (CY) 2017 ASC payment rates for covered surgical and ancillary services (ASCFS file), and an ASC Code Pair file, if applicable.

Effective date: October 2, 2017
Implementation dates:  October 2, 2017

 

HIGLAS Enhancement Required for Implementation of Overpayment based Denials
On September 1, CMS published CMS One-Time Notification Transmittal 1912, which lays out the requirements that are specific to HIGLAS for implementation of Overpayment based Denials.

Effective date: April 1, 2018
Implementation dates: April 2, 2018

 

Revision to Publication 100-06, Chapter 3, Medicare Overpayment Manual, Section 200, Limitation on Recoupment
On September 1, CMS published CMS Medicare Financial Management Transmittal 292, which updates the Medicare Overpayment Manual, section 200-200.2.1, Limitation on Recoupment.

Effective date: April 2, 2018
Implementation dates: April 2, 2018