This week in Medicare updates–11/2/2016
FY 2017 Dialysis Facility Reports (DFR) and End Stage Renal Disease (ESRD) Core Survey Materials Released
On October 21, CMS announced the release of materials used for ESRD surveys that have been updated for FY 2017, including the FY 2017 DFR, Pre-survey DFR Extract files, and State profiles, which are available to authorized State Survey Agency (SA) personnel. The ESRD Core Survey Data Worksheet and other ESRD Core Survey materials have been revised for FY 2017 to align with the FY 2017 DFR.
View the announcement.
Impact of Nursing Shortage on Hospice Care
On October 21, CMS announced that it has extended the period of time for hospice agencies to elect an exemption to allow for the contracting of nurses pursuant to “extraordinary circumstance” as noted at 42 CFR 418.64 when they believe the nursing shortage has affected their ability to hire. The policy is effective through September 30, 2018.
View the announcement.
Save the Date: Training for Phase 1 Implementation of New Nursing Home Regulations
On October 24, CMS announced it’s developing an online training for Regional Offices (RO), State Survey Agencies (SA), providers, and other stakeholders on the new Nursing Home Regulations. The online training will include information about Phase 1 of new Nursing Home Regulations, and will be available to all parties starting November 18, 2016. All long-term care (LTC) surveyors are required to complete this training in order to be able to conduct any LTC surveys after November 28, 2016.
View the announcement.
Arizona Did Not Always Verify Correction of Deficiencies Identified During Surveys of Nursing Homes Participating in Medicare and Medicaid
On October 24, the OIG posted a report regarding the Arizona Department of Health Services, Division of Licensing Services, Bureau of Long-Term Care Licensing, which did not always verify nursing homes' correction of deficiencies identified during surveys in calendar year 2014. For the 100 sampled deficiencies, the agency verified the nursing homes' correction of 58 deficiencies but did not obtain the nursing homes' evidence of correction for the remaining 42 deficiencies, which were all less serious deficiencies. The OIG estimates that the the agency did not verify nursing homes' correction of deficiencies for 56% of the 650 deficiencies identified during surveys in CY 2014.
View the report.
OIG announces CIA with Forrest Preston and Life Care Centers of America
On October 24, the OIG posted an announcement regarding a Corporate Integrity Agreement (CIA) with Forrest Preston and Life Care Centers of America (LCCA). The CIA covers all skilled nursing facilities owned, operated, affiliated with or managed by LCCA.
View the announcement.
New York Made Some Incorrect Medicaid EHR Incentive Payments
On October 24, the OIG released a report detailing incorrect electronic health record (EHR) incentive payments made by the New York State Department of Health. The state made incorrect EHR incentive payments to two hospitals totaling $175,000. The adjustments to the payments total $19,000. The State agency correctly paid the five professionals reviewed by the OIG.
View the report.
Program for Parallel Review of Medical Devices
On October 24, CMS announced a joint pilot program with the Food and Drug Administration (FDA) in the Federal Register, introducing the parallel review of medical devices. The program is a collaborative effort intended to reduce the time between FDA marketing approval or FDA's granting of a de novo request and Medicare coverage decisions through National Coverage Determinations (NCD).
View the Federal Register.
Quality Payment Program Fact Sheet
On October 25, CMS released a Fact Sheet regarding its final rule with a comment period implementing the Quality Payment Program that is part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
View the Fact Sheet.
Opportunities for clinicians to join innovative care approaches under the Quality Payment Program
On October 25, CMS released a press release regarding new opportunities for clinicians to join Advanced Alternative Payment Models developed by the CMS Innovation Center to improve care and potentially earn an incentive payment under the Quality Payment Program created through the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
View the press release.
Vermont All-Payer ACO Model
On October 26, CMS released a press release and Fact Sheet regarding the Vermont All-Payer Accountable Care Organization (ACO) Model. The model is a new test of an alternative payment model in which the most significant payers throughout the state (Medicare, Medicaid, and commercial payers) incentivize healthcare value and quality, with a focus on health outcomes, under the same payment structure for the majority of providers throughout the state’s care delivery system and transform health care for the entire state and its population.
View the press release.
View the Fact Sheet.
Listening Session Regarding the Implementation of Certain Medicare Part D Provisions in the Comprehensive Addiction and Recovery Act of 2016
On October 26, CMS announced a Listening Session in the Federal Register to solicit input from stakeholders regarding our implementation of section 704 of the Comprehensive Addiction and Recovery Act of 2016, which includes provisions to permit Part D sponsors to establish drug management programs for at-risk beneficiaries under which Part D sponsors may limit such beneficiaries' access to frequently abused drugs to certain prescribers and pharmacies.
View the Federal Register.
Denial of Home Health Payments When Required Patient Assessment Is Not Received
On October 26, CMS released Transmittal 3629 to automate the denial of home health prospective payment system (HH PPS) claims when the condition of payment for submitting patient assessment data has not been met.
Effective date: April 1, 2017
Implementation date: April 3, 2017
View the transmittal.
Phase 3 - Updating the Fiscal Intermediary Shared System (FISS) to Make Payment for Drugs and Biologicals Services for Outpatient Prospective Payment System (OPPS) Providers
On October 26, CMS released Transmittal 1734 to implement an additional system change necessary to the Fiscal Intermediary Shared System (FISS) and Integrated Outpatient Code Editor (IOCE) necessary to make payment for drugs and biologicals to Outpatient Prospective Payment System (OPPS) providers.
Effective date: January 1, 2017
Implementation date: April 3, 2017
View the transmittal.
Correcting Editing for Condition Code 54 and Updating Remittance Advice Messages on Home Health Claims
On October 27, CMS released Transmittal 3630 to correct Medicare systems to require condition code 54 on home health appropriately. The transmittal also updates remittance advice coding combinations to ensure compliance with industry standards.
Effective date: April 1, 2017
Implementation date: April 3, 2017
View the transmittal.
Phase Three: Changing FISS Action on Informational Unsolicited Responses From Canceled Claims to Adjustments
On October 27, CMS released Transmittal 1732 to ensure that Fiscal Intermediary Shared System (FISS) processes all Informational Unsolicited Responses (IUR) as adjustments.A large volume of IURs were generated in error due to a change in the data file received from the Social Security Administration, resulting in the need to reverse many canceled claims. However, when claims are canceled in error they have to be resubmitted by the provider or recreated by the system maintainer to be reconsidered for payment.
Effective date: April 1, 2017
Implementation date: April 3, 2017
View the transmittal.
Modifications to the National Coordination of Benefits Agreement (COBA) Crossover Process
On October 27, CMS released Transmittal 1733 to modify the Part A shared system to ensure that all 837 institutional Coordination of Benefits (COB) claims will contain a Claim Adjustment Reason Code and Remittance Advice Remark Code combination as required and as reported on the 835 Electronic Remittance Advice that has been sent to the provider. CMS is also modifying the Part A shared system to ensure that hospital day counts may not be entered duplicatively on incoming claims submissions to Medicare and that Present on Admission (POA) indicators are only permitted on incoming inpatient hospital-oriented claims.
Effective date: April 1, 2017
Implementation date: April 3, 2017
View the transmittal.
Approval of Request for an Exception to the Prohibition on Expansion of Facility Capacity Under the Hospital Ownership and Rural Provider Exceptions to the Physician Self-Referral Prohibition for Deaconess Women's Hospital of Southern Indiana
On October 28, CMS announced an Approval of a Request for an Exception in the Federal Register regarding its decision to approve the request of Deaconess Women's Hospital of Southern Indiana to do business as The Women's Hospital (The Women's Hospital) for an exception to the prohibition on expansion of facility capacity.
View the Federal Register.
Approval of Request for an Exception to the Prohibition on Expansion of Facility Capacity Under the Hospital Ownership and Rural Provider Exceptions to the Physician Self-Referral Prohibition for Rockwall Regional Hospital
On October 28, CMS announced an Approval of a Request for an Exception in the Federal Register regarding its decision to approve Rockwall Regional Hospital, LLC’s request to do business as Texas Health Presbyterian Hospital Rockwall (Texas Health Rockwall) for an exception to the prohibition on expansion of facility capacity.
View the Federal Register.
Dialysis Facility Compare, Star Ratings and Data Release
On October 28, CMS released a Fact Sheet regarding CMS’ addition of patient experience survey results, two new clinical quality measures, and updated star rating calculations on the Dialysis Facility Compare website. The website also reflects improvements to make it easier for consumers to find and understand complex quality information.
View the Fact Sheet.