This week in Medicare updates–10/19/2016
Update to Table of Chemistry Panels
On Friday, October 7, 2016, CMS posted Transmittal 3619, correcting the Table of Chemistry Panels in Chapter 16, subsection 90.2 of Pub. 100-04, to clarify CPT code 84075 (Alkaline phosphatase) should be listed under code 80053 (Comprehensive Metabolic panel).
Effective date: January 10, 2017
Implementation date: January 10, 2017
View the transmittal.
Billing of Vaccine Services on Hospice Claims
On Friday, October 7, 2016, CMS posted Transmittal 3621 and revised MLN Matters MM9052 to correct information regarding the billing of vaccines. Transmittal 3621 replaces Transmittal 3540, dated June 10, 2016, which has been rescinded. The policy section of the business requirement form, BR 9052.3 and Pub. 100-04, chapter 18, section 10.2.2.1 are revised to indicate cost reimbursement for vaccines and fee schedule payment for administration.
Effective date: October 1, 2016
Implementation date: October 3, 2016
View the transmittal.
View the MLN Matters article.
Update to Pub 100-04, Medicare Claims Processing Manual, Chapter 15: Ambulance
On Friday, October 7, 2016, CMS posted Transmittal 3620 to update Chapter 15 of the Medicare Claims Processing Manual with information pertaining to the Skilled Nursing Facility Prospective Payment System and consolidated billing.
Effective date: November 8, 2016
Implementation date: November 8, 2016
View the transmittal.
Common Working File Reorganization of Daily Beneficiary Extract Files
On Friday, October 7, 2016, CMS posted Transmittal 1724, in which CMS requests that the Common Working File maintainer, MBD and NGD contractors implement analysis performed under CMS CR 9451. During analysis under CMS CR 9451, all three systems, CWF, MBD, and NGD, agreed to reformat existing data elements and make additional room for future use, eliminating the need for splitting each beneficiary extract record into multiple records per beneficiary.
Effective date: April 1, 2017
Implementation date: April 3, 2017
View the transmittal.
Provider Reimbursement Manual - Part 2, Provider Cost Reporting Forms and Instructions, Chapter 32, Form CMS-1728-94
On Friday, October 7, 2016, CMS posted Transmittal 17, revising the Medicare Provider Reimbursement Manual, Part 2, Provider Cost Reporting Forms and Instructions, Chapter 32, Form CMS-1728-94. The transmittal updates the Home Health Agency Cost Report (Form CMS-1728-94) in accordance with the statutory requirement for hospice payment reform in §3132 of the Patient Protection and Affordable Care Act (ACA) and incorporates data previously reported on the Provider Cost Report Reimbursement Questionnaire, Form CMS-339.
Effective dates:
New Cost Reporting Forms and Instructions: Home Health Agency cost report changes effective for cost reporting periods beginning on or after October 1, 2015.
Electronic Specifications: Electronic reporting specifications are effective for cost reporting periods beginning on or after October 1, 2015.
View the transmittal.
IT Control Weaknesses Found at the Minnesota Health Insurance Exchange
On Monday, October 10, 2016, the OIG posted a report on the Minnesota's Health Insurance Marketplace information technology (IT) control weaknesses. Though it had implemented security controls, policies, and procedures intended to prevent vulnerabilities in its website), database, and other supporting information systems, it did not always comply with federal and state IT requirements.
View the report.
Sleep Health Center Billed Medicare for Some Unallowable Sleep Study Services
On Monday, October 10, 2016, the OIG posted a report on Sleep Health Center (Sleep Health), based in Fort Myers, Florida, which billed Medicare claims for polysomnography services that did not always comply with Medicare billing requirements. Of the 100 randomly selected beneficiaries reviewed, Sleep Health billed Medicare claims for polysomnography services that met Medicare billing requirements for 36 beneficiaries with 137 corresponding lines of service. However, Sleep Health billed Medicare claims for the remaining 64 beneficiaries with 149 corresponding lines of service that did not meet Medicare requirements, resulting in overpayments totaling $49,000.
View the report.
Medicare Compliance Review of Bergan Mercy Medical Center for 2013 and 2014
On Monday, October 10, 2016, the OIG posted a report on Bergan Mercy Medical Center in Omaha, Nebraska, which complied with Medicare billing requirements for 219 of the 224 outpatient and inpatient claims reviewed. The hospital did not fully comply with Medicare billing requirements for the remaining five claims, resulting in overpayments of $70,000 for calendar years 2013 and 2014. Specifically, three outpatient claims had billing errors, resulting in overpayments of $63,000, and two inpatient claims had billing errors, resulting in overpayments of $7,000.
View the report.
OIG Advisory Opinion No. 16-10
On Monday, October 10, 2016, the OIG posted Advisory Opinion No. 16-10, regarding a local healthcare district's proposal to cooperate with another district to jointly fund the cost of a transportation coordinator to educate patients about local transportation options and subsidize certain forms of transportation for patients with financial need.
View the document.
2017 Star Ratings
On Tuesday, October 11, 2016, CMS published a Fact Sheet regarding the 2017 Star Ratings, including evidence that Star Ratings are driving improvement in Medicare quality. CMS publishes the Part C and D Star Ratings each year to measure quality in Medicare Advantage and Prescription Drug Plans, assist beneficiaries in finding the best plan for them, and determine Medicare Advantage Quality Bonus Payments.
View the Fact Sheet.
Notice of New Interest Rate for Medicare Overpayments and Underpayments (1st Quarter Notification for FY2017)
On Wednesday, October 12, 2016, CMS posted Transmittal 273, regarding Medicare Regulation 42 CFR 405.378, which provides for the charging and payment of interest on overpayments and underpayments to Medicare providers. The Secretary of Treasury certifies an interest rate quarterly, using the most comprehensive data available on consumer interest rates. Interest is assessed on delinquent debts to protect the Medicare Trust Funds. The Recurring Update Notification applies to Chapter 3, Section 10.
Effective date: October 18, 2016
Implementation date: October 18, 2016
View the transmittal.
CMS initiative to increase clinician engagement
On Thursday, October 13, 2016, CMS announced a new initiative to improve the clinician experience with the Medicare program. The initiative will aim to reshape the physician experience by reviewing regulations and policies to minimize administrative tasks and seek other input to improve clinician satisfaction as CMS implements Affordable Care Act and Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) reforms.
View the press release.
Reducing medical record review for clinicians participating in certain Advanced Alternative Payment Models
On Thursday, October 13, 2016, CMS published a Fact Sheet announcing an 18-month pilot program to reduce medical record review for certain physicians while continuing to protect program integrity. Under the program, providers practicing within certain Advanced Alternative Payment Models will be relieved of additional scrutiny under certain Medicare medical review programs.
View the Fact Sheet.
Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models Final Rule with Comment Period
On Friday, October 14, 2016, CMS issued a final rule with comment period implementing the Quality Payment Program, which is part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The Quality Payment Program policy will reform Medicare payments for more than 600,000 clinicians across the country. Physicians can choose from two options on how to participate in the Quality Payment Program based on practice size, specialty, location, or patient population:
- Advanced Alternative Payment Models (APM)
- Merit-based Incentive Payment System (MIPS)
This final rule establishes incentives for participation in APMs and includes the criteria for use by the Physician-Focused Payment Model Technical Advisory Committee in making comments and recommendations on physician-focused payment models. Alternative Payment Models are payment approaches, developed in partnership with the clinician community, that provide added incentives to deliver high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population.
This final rule with comment period also establishes the MIPS, a new program for certain Medicare-enrolled practitioners. MIPS will consolidate components of three existing programs, the Physician Quality Reporting System (PQRS), the Physician Value-based Payment Modifier (VM), and the Medicare Electronic Health Record (EHR) Incentive Program for Eligible Professionals (EPs), and will continue the focus on quality, cost, and use of certified EHR technology (CEHRT) in a cohesive program that avoids redundancies.
CMS has also rebranded key terminology in the rule according to feedback from stakeholders, with the goal of selecting terms that will be more easily identified and understood by stakeholders.
The comment period will be open for 60 days after the date of filing.
Effective date: January 1, 2017
View the final rule.
View the executive summary.
View the fact sheet.
View the press release.
Medicare Program; Explanation of FY 2004 Outlier Fixed-Loss Threshold as Required by Court Rulings; Correction
On Friday, October 14, 2016, CMS posted in the Federal Register regarding the correction of a technical error that appeared in the document published in the January 22 Federal Register, “Medicare Program; Explanation of FY 2004 Outlier Fixed-Loss Threshold as Required by Court Rulings.” In the previously published discussion of the cost-to-charge ratios estimates, CMS made an error regarding the fiscal year.
View the Federal Register.
Comment Request: Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CMS-10169)
On Friday, October 14, 2016, CMS posted a Comment Request in the Federal Register regarding the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program Change of Ownership Forms. CMS is seeking approval to collect the information in Forms A and B for competitions that will occur before 2017. For these upcoming competitions CMS will publish a slightly modified version of the RFB instructions and accompanying Forms A and B so that suppliers will be better able to identify and understand the requirements of the program.
Comments must be received by December 13.
View the Federal Register.
Comment Request: CMS-2744 End Stage Renal Disease (ESRD) Medical Information Facility Survey
On Friday, October 14, 2016, CMS posted a Comment Request in the Federal Register regarding an extension of a previously approved collection; Title of Information Collection: End Stage Renal Disease (ESRD) Medical Information Facility Survey. The ESRD Program Management and Medical Information System (PMMIS) Facility Certification/Survey Record contains provider-specific and aggregate patient population data on beneficiaries treated by that provider obtained from the Annual Facility Survey form (CMS-2744). The Facility Certification portion of the record captures certification and other information about ESRD facilities approved by Medicare to provide kidney dialysis and transplant services. The Facility Survey portion of the record captures activities performed during the calendar year as well as aggregate year-end population counts for both Medicare beneficiaries and non-Medicare patients.
Comments must be received by December 13, 2016.
View the Federal Register.
Comment Request: Generic Clearance for Evaluation of Stakeholder Training--Health Insurance Marketplace and Market Stabilization Programs
On Friday, October 14, 2016, CMS posted a Comment Request in the Federal Register regarding a new collection of information; Generic Clearance for Evaluation of Stakeholder Training--Health Insurance Marketplace and Market Stabilization Programs. CMS is strongly committed to providing appropriate education and technical outreach to States, issuers, self-insured group health plans, and third-party administrators (TPA) participating in the Marketplace and/or market stabilization programs mandated by the ACA. CMS continues to engage with stakeholders in the Marketplace to obtain input through Satisfaction Surveys following Stakeholder Training events. The survey results will help to determine stakeholders' level of satisfaction with trainings, identify any issues with training and technical assistance delivery, clarify stakeholders' needs and preferences, and define best practices for training and technical assistance.
Comments must be received by November 14.
View the Federal Register.
Comment Request: Evaluating a Pilot Mobile Health Program
On Friday, October 14, 2016, CMS posted a Comment Request in the Federal Register regarding a new collection of information; Evaluating a Pilot Mobile Health Program. CMS is supporting a pilot mobile health (mHealth) program in California, Louisiana, Ohio, and Oklahoma. The three-year mHealth project is being conducted to complement existing CMCS measurement, data collection, and reporting activities to monitor, track, and assess state's maternal and infant health efforts in Medicaid and CHIP populations. This information collection request supports the evaluation of the pilot mHealth program and will be used to assist CMS in tracking maternal and infant health outcomes in the Medicaid population. The methods used for collection and analysis of the data may be useful to states and serve to increase reporting of perinatal core set measures and monitoring and interpretation of state- level maternal and infant health efforts. Results from the evaluation will help CMS understand the usefulness of mobile technology for conveying health information to pregnant women and new mothers enrolled in Medicaid/CHIP, as well as the influence this information has on health behaviors and outcomes.
Comments must be received by December 13.
View the Federal Register.