This week in Medicare updates–09/21/2016
Certification Number (CCN) state codes–State Operations Manual (SOM) section 2779A revisions
On September 8, CMS posted a survey and certification letter regarding revisions to this section in the SOM which provides guidance regarding the numbering system for CCNs for Medicare-participating providers and suppliers. The revision, specifically in Section 2779A1 for Medicare providers reflects the addition of new state codes. Due to a lack of available CCNs for some providers wishing to enroll or modify their current certification in Medicare, additional state codes are being added to the Automated Survey Processing Environment, the Accrediting Organization System for Storing User Recorded Experiences, as well as Medicare payment processing systems, effective October 1.
View the survey and certification letter.
Notice of interim final rule adjusting Civil Monetary Penalties (CMP)
On September 8, HHS posted a survey and certificated letter regarding an interim final rule which adjusts for inflation CMP amounts authorized under the Social Security Act (see Adjustment of Civil Monetary Penalties for Inflation). The interim final rule establishes new section 45 CFR Part 102, which lists the new CMP amounts and ranges as adjusted by the interim final rule for affected regulations. The changes made by the interim final rule are effective on September 6. The interim final rule addresses all applicable CMPs under the authority of HHS but CMS is highlighting only on those CMPs assessed for SNFs, nursing facilities, SNFs/NFs, home health agencies, and clinical laboratories.
View the survey and certification letter.
Revision to transmittal regarding ambulance staffing requirements
On September 12, CMS rescinded Transmittal 225, dated September 9, and replaced it with Transmittal 226 to correct the implementation date in the manual instruction to December 12. All other information remains the same.
Effective date: January 1, 2016
Implementation date: December 12, 2016
View Transmittal R226BP.
View MLN Matters article MM9761.
2016-2017 influenza (flu) resources for healthcare professionals
On September 12, CMS posted a special edition MLN Matters article reminding healthcare professionals that Medicare Part B reimburses providers for flu vaccines and the administration of these vaccines. CMS also reminded healthcare professionals that they can reduce the risk of Medicare patients contracting seasonal flu and serious complications by using every office visit as an opportunity to recommend they take advantage of Medicare’s coverage of the annual flu shot.
View MLN Matters article SE1622.
Submission for OMB Review, Comment Request
On September 12, CMS posted a notice in the Federal Register stating that it is accepting comments on CMS–588, Electronic Funds Transfer Authorization Agreement; CMS– 10146, Medicare Part D Reporting Requirements and Supporting Regulations; CMS–10185, Part C Medicare Advantage Reporting Requirements and Supporting Regulations in 42 CFR 422.516(a); CMS–10261, Notice of Denial of Medicare Prescription Drug Coverage; and CMS– 10631, The PACE Organization Application Process in 42 CFR part 460. Comments are due October 12.
View the notice in the Federal Register.
Leave a comment.
Inpatient hospital reviews resume
On September 12, CMS posted an update on its Inpatient Hospital Reviews webpage announcing that, effective September 12, BFCC-QIOs will resume initial patient status reviews of short stays in acute care inpatient hospitals, long-term care hospitals, and inpatient psychiatric facilities to determine the appropriateness of Part A payment for short stay hospital claims.
View the Inpatient Hospital Reviews webpage.
Fee-For-Service Data Collection System: Clinical Laboratory Fee Schedule (CLFS) Data Reporting Template
On September 14, CMS released a revised version of MLN Matters article SE1620. The attached manual was updated and the illustrations for Notepad and Excel were changed. In the table on page 3, the field name "test name" was removed. All other information is unchanged.
This article is to assist the laboratory community in meeting the new requirements for the Medicare Part B CLFS. The Quick User Guide, which includes guidance for the Fee-For-Service Data Collection System CLFS data reporting template, is included as an attachment in this article.
View MLN Matters article SE1620.
Updates to the 72X Type of Bill for home and self-dialysis training, retraining, and nocturnal hemodialysis
On September 16, CMS released a change request implementing training treatment limits, billing requirements for retraining, and reporting for nocturnal hemodialysis.
Effective date: January 1, 2017, for BR 8; April 1, 2017, for BRs 1 and 2; July 1, 2017, for BRs 3 through 7
Implementation date: January 3, 2017, for BR 8; April 3, 2017, for BRs 1 and 2; July 3, 2017, for BRs 3 through 7
View Transmittal R1715OTN.
Clarification of certain policies in Pub. 100-08, Medicare Program Integrity, Chapter 15 regarding the processing of Form CMS-855R applications
On September 16, CMS released a change request to clarify certain policies in chapter 15 of Pub. 100-08 concerning the processing of Form CMS-855R applications. This change request also adds to Chapter 15 a supplementary guide that educates providers and suppliers on the preparation and submission of reassignment applications.
Effective date: December 19, 2016
Implementation date: December 19, 2016
View Transmittal R676PI.
Internet Only Manual updates to Pub. 100-01, Medicare General Information, Eligibility, and Entitlement Manual, 100-02, Medicare Benefit Policy Manual, and 100-04, Medicare Claims Processing Manual to correct errors and omissions related to SNF policies
On September 16, CMS released three change requests to update three Medicare manuals to correct various minor technical errors and omissions. These changes are intended only to clarify the existing content and no policy, processing, or system changes are anticipated.
Effective date: October 18, 2016
Implementation date: October 18, 2016
View Transmittal R3612CP.
View Transmittal R227BP.
View Transmittal R101GI.
Kansas physical therapy practice claimed unallowable Medicare Part B reimbursement for some outpatient physical therapy services
On September 15, the OIG posted a report stating that a Kansas physical therapy practice claimed Medicare reimbursement for some outpatient physical therapy services that did not meet Medicare reimbursement requirements. Of the 100 beneficiary days in the random sample, the practice properly claimed Medicare reimbursement on 71 beneficiary days. The practice improperly claimed Medicare reimbursement on the remaining 29 beneficiary days. On the basis of the OIG’s sample results, it estimated that the practice improperly received at least $134,000 in Medicare reimbursement for outpatient physical therapy services that did not comply with certain Medicare requirements.
View the report.
Hospices should improve election statements and certifications of terminal illness
On September 15, the OIG posted a report stating that hospice election statements lacked required information or had other vulnerabilities in more than one-third of general inpatient care (GIP) stays. Notably, they did not always mention as required that the beneficiary was waiving coverage of certain Medicare services by electing hospice care or that hospice care is palliative rather than curative. Further, in 14% of GIP stays, the physician did not meet requirements, such as composing a narrative, when certifying, and appeared to have limited involvement in determining that the beneficiary was appropriate for hospice care.
View the report.
NCA for supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD)
On September 15, CMS posted a tracking sheet in reference to the NCA regarding coverage of SET for the treatment of PAD. CMS is soliciting public comment relevant to this NCA. It is particularly interested in comments that include scientific evidence.
View the tracking sheet.
Renal denervation in the Medicare population
On September 15, CMS posted a technology assessment with appendix regarding the NCA to evaluate the effectiveness of renal denervation for resistant hypertension, and determine its applicability to the Medicare population.
View the technology assessment and appendix.
Emergency preparedness requirements for Medicare and Medicaid participating providers and suppliers
On September 16, CMS posted a final rule in the Federal Register establishing national emergency preparedness requirements for Medicare- and Medicaid-participating providers and suppliers to plan adequately for both natural and manmade disasters, and coordinate with federal, state, tribal, regional, and local emergency preparedness systems. It will also assist providers and suppliers to adequately prepare to meet the needs of patients, residents, clients, and participants during disasters and emergency situations. Despite some variations, the regulations are meant to provide consistent emergency preparedness requirements, enhance patient safety during emergencies for persons served by Medicare- and Medicaid-participating facilities, and establish a more coordinated and defined response to disasters. It is effective November 15.
View the final rule in the Federal Register.
View the press release.
View the survey and certification letter.