This week in Medicare updates–11/23/2016
Calendar Year (CY) 2017 Participation Enrollment and Medicare Participating Physicians and Suppliers Directory (MEDPARD) Procedures
On November 8, CMS published Transmittal 3648, which rescinds and replaces Transmittal 3639, dated October 28, 2016, to remove the Sensitive/Controversial designation and to include the revised attachment. All other information remains the same.
Effective date: October 28, 2016
Implementation date: November 8, 2016
Guidance to Physician/Practitioner and Supplier Billing Offices that Submit Hard Copy Claims to Medicare to Help Reduce Incidence of Claims Not Crossing Over Due to Duplicate Diagnosis Codes and Diagnosis Code Pointers
On November 8, CMS published MLN Matters® SE1629, which contains guidance for physicians/practitioners and medical suppliers that CMS hopes will help result in fewer issues with Medicare crossing their claims over to supplemental payers.
Comprehensive Error Rate Testing (CERT) Program: Medicare Administrative Contractor (MAC) Certifying Official
On November 10, CMS published Transmittal 686 regarding the update Chapter 12 of Pub. 100-08, which instructs MACs to submit a certification for information entered on the Claims Status Website (CSW).
Effective date: December 12, 2016
Implementation date: December 12, 2016
Implementation of Policy Changes for the CY 2017 Home Health Prospective Payment System
On November 10, CMS published Transmittal 3655 and MLN Matters 9736, which rescind and replace Transmittal 3585, dated August 12, 2016. Transmittal 3655 revises the position numbers in Pricer record layout in section 70.2, to add language defining negative pressure wound therapy to section 90.3, removes the Sensitive/Controversial designation, and updates Attachment 1 to reflect final rates.
Effective date: January 1, 2017
Implementation date: January 3, 2017
2017 Annual Update to the Therapy Code List
On November 10, CMS published Transmittal 3654 and MLN Matters 9782, which update the list of codes used to describe therapy services. The additions, changes, and deletions to the therapy code list reflect those made in the CY 2017 HCPCS and CPT manuals.
Effective date: January 1, 2017
Implementation date: January 3, 2017
Fiscal Intermediary Shared System (FISS) Implementation of the Restructured Clinical Lab Fee Schedule (CLFS)
On November 10, CMS published Transmittal 3653 and MLN Matters 3653CP to inform MACs about the changes to the FISS to incorporate the revised CLFS containing the National fee schedule rates.
Effective date: January 1, 2018
Implementation date: July 3, 2017
Update of Chapter 1 of the Managed Care Manual
On November 10, CMS published Transmittal 124, reorganizing its content to reflect changes in policy made in the last three years.
Effective date: November 10, 2016
Implementation date: November 10, 2016
Payment for Oxygen Volume Adjustments and Portable Oxygen Equipment
On November 10, CMS published Transmittal 3649 and MLN Matters 9848, which seek to remind contractors of instructions located at section 130.6 of chapter 20 of the Medicare Claims Processing Manual (Pub.100-04). The instructions in this section were originally furnished Transmittal 1310 and provide the instructions for Medicare contractors involved in processing claims for oxygen and oxygen equipment under the Medicare Part B benefit for durable medical equipment.
Effective date: April 1, 2017
Implementation date: April 3, 2017
Updates to Pub. 100-04, Chapters 8, 13 and 14 to Correct Remittance Advice Messages
On November 10, CMS published Transmittal 3650 and MLN Matters 9841 regarding the revision of chapters 8, 13, and 14 of the Medicare Claims Processing Manual to ensure that all remittance advice coding is consistent with nationally standard operating rules. It also provides a format for consistently showing remittance advice coding throughout the manual.
Effective date: February 10, 2017
Implementation date: February 10, 2017
Michigan Health Services Initiative
On November 14, CMS posted a Fact Sheet regarding its approval of a Michigan State Plan Amendment (SPA) for a Title XXI state-designed Health Services Initiative (HSI) for expanded lead abatement activities in the impacted areas of Flint, Michigan and other areas within the state. The targeted and time-limited HSI will complement other federal, state, and local efforts to abate lead hazards from the homes and improve the health of Medicaid- and Children’s Health Insurance Program (CHIP)-eligible individuals.
Update to the Medicare Drug Spending Dashboard
On November 14, CMS posted a Fact Sheet regarding its update to the Medicare Drug Spending Dashboard to include information for 2015. The dashboard presents information for three categories of Medicare prescription drugs for both Part B and Part D: drugs with high spending on a per user basis, drugs with high spending for the program overall, and drugs with high unit cost increases in recent years.
Hospital Appeals Settlement Process National Provider Call materials available
On November 14, CMS posted the slides for the November 16, 2016 MLN Connects National Provider Call in the "Downloads" section of the Hospital Appeals Settlement Process 2016 website.
Proposed Decision Memo on Leadless Pacemakers
On November 14, CMS posted a proposed decision memo on Leadless Pacemakers (CAG-00448N). CMS proposes to cover FDA-approved studies for leadless pacemakers through Coverage with Evidence Development (CED).
Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Organ Procurement Organization Reporting and Communication; Transplant Outcome Measures and Documentation Requirements; Electronic Health Record (EHR) Incentive Programs; Payment to Nonexcepted Off-Campus Provider-Based Department of a Hospital; Hospital Value-Based Purchasing (VBP) Program; Establishment of Payment Rates Under the Medicare Physician Fee Schedule for Nonexcepted Items and Services Furnished by an Off-Campus Provider-Based Department of a Hospital
On November 14, CMS published the Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; etc. final rule in the Federal Register.
New Jersey OB/GYN Settles Fraudulent Billing Allegations, Agrees to 20-Year Exclusion from Medicare, Medicaid
On November 15, the OIG published a press release and updated its Civil Monetary Penalties and Affirmative Exclusions website to include information on New Jersey OB/GYN, Labib Riachi, who agreed to be excluded from participation in federal healthcare programs, including Medicare and Medicaid, for 20 years to settle allegations by the OIG after submitting thousands of claims for Pelvic Floor Therapy (PFT) to Medicare and Medicaid for services that were either never provided or were otherwise false or fraudulent. The OIG exclusion follows a False Claims Act settlement by Riachi, in which he agreed to pay $5.25 million.
CY 2017 Inpatient Hospital Deductible and Hospital and Extended Care Services Coinsurance Amounts
On November 15, CMS published its CY 2017 Inpatient Hospital Deductible and Hospital and Extended Care Services Coinsurance Amounts in the Federal Register.
Medicare Part B Monthly Actuarial Rates, Premium Rate, and Annual Deductible Beginning January 1, 2017
On November 15, CMS published its Medicare Part B Monthly Actuarial Rates, Premium Rate, and Annual Deductible Beginning January 1, 2017 in the Federal Register.
CY 2017 Part A Premiums for the Uninsured Aged and for Certain Disabled Individuals Who Have Exhausted Other Entitlement
On November 15, CMS published its CY 2017 Part A Premiums for the Uninsured Aged and for Certain Disabled Individuals Who Have Exhausted Other Entitlement in the Federal Register.
Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers; Correction
On November 16, CMS published a Correction to its Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers in the Federal Register.
Changes to the Laboratory National Coverage Determination (NCD) Edit Software for January 2017
On November 16, CMS published Transmittal 3656, which rescinds and replaces Transmittal 3628, dated October 21, 2016, to change the implementation date to December 5, 2016. All other information remains the same. CMS also revised MLN Matters 9806 to reflect this change.
Effective date: October 1, 2016
Implementation date: December 5, 2016
Coding Revisions to National Coverage Determinations (NCD)
On November 17, CMS published Transmittal 1753, which rescinds and replaces Transmittal 1708, dated August 19, 2016, to change the following:
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NCD180.1, change 7/1/16 effective date in spreadsheet history to 1/1/16
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NCD160.18, remove reactivation of MCS 012L from spreadsheet history and business requirement
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NCD220.6.20, remove reference to 'primary diagnosis' regarding diagnosis code Z00.6 in spreadsheet
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Reference FISS new RC for value code D4 in spreadsheet history
CMS also revised MLN Matters 9751 to include these changes.
Effective date: January 1, 2017, unless otherwise noted
Implementation date: January 3, 2017
Provider Reimbursement Manual Hospital and Hospital Health Care Complex Cost Report Form CMS-2552-10 updates
On November 17, CMS published Transmittal 10 regarding updates to Chapter 40, Hospital and Hospital Health Care Complex Cost Report Form CMS-2552-10, by introducing new Worksheet N series for hospital-based Federally Qualified Health Centers (FQHC), effective for cost reporting period beginning on or after October 1, 2014, in accordance with the statutory requirements of §10501(i)(3)(A) of the Patient Protection and Affordable Care Act (ACA), and new Worksheet O series for hospital-based hospices, effective or cost reporting periods beginning on or after October 1, 2015, in accordance with the statutory requirements of §3132 of the ACA. The transmittal also clarifies and corrects the existing instructions and incorporates additional statutory and regulatory changes.
Effective date: Cost Reporting Periods Ending on or After September 30, 2016
Top 10 Management and Performance Challenges
On November 17, the OIG posted a Report on the Top 10 Management and Performance Challenges facing HHS.
CMS launches new online tool to make Quality Payment Program easier for clinicians
On November 17, CMS posted a press release regarding a new tool to share automatically electronic data for the Medicare Quality Payment Program. This new release is the first in a series that will be part of CMS’s ongoing efforts to spur the creation of innovative, customizable tools to reduce burden for clinicians, while also supporting high-quality care for patients.
Retinal Prostheses Technology Assessment
On November 17, CMS posted a Technology Assessment report regarding Retinal Prostheses in the Medicare Population.
ICD-10 Coding Revisions to National Coverage Determination (NCD)
On November 18, CMS published Transmittal 1755 regarding the 10th maintenance update of ICD-10 conversions and other coding updates specific to NCDs. The NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received.
Effective date: October 1, 2016
Implementation dates:
January 20, 2016 - A/B MAC local systems
April 3, 2017 - FISS, MCS, CWF Shared systems
Pub. 100-06, Chapter 3, Section 90 (Provider Liability) Revision
On November 18, CMS published Transmittal 275 to provide additional criteria for determining when a contractor shall assume a provider, physician, or other supplier should have known about a policy or rule.
Effective date: February 21, 2017
Implementation date: February 21, 2017
Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print Update
On November 18, CMS published Transmittal 3660 and MLN Matters 9774 to update the RARC and CARC lists and also to instruct ViPS Medicare System (VMS) and Fiscal Intermediary Shared System (FISS) to update MREP and PC Print.
Effective date: April 1, 2017
Implementation date: April 3, 2017
Claims Status Category and Claims Status Codes Update
On November 18, CMS published Transmittal 3551 and MLN Matters 9769 to update, as needed, the Claim Status and Claim Status Category Codes used for the Accredited Standards Committee (ASC) X12 276/277 Health Care Claim Status Request and Response and ASC X12 277 Health Care Claim Acknowledgment transactions.
Effective date: April 1, 2017
Implementation date: April 3, 2017
Correction: Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2017; Medicare Advantage Bid Pricing Data Release; Medicare Advantage and Part D Medical Loss Ratio Data Release; Medicare Advantage Provider Network Requirements; Expansion of Medicare Diabetes Prevention Program Model; Medicare Shared Savings Program Requirements
On November 18, CMS published Corrections to its 2017 Physician Fee Schedule, etc., final rule in the Federal Register.
OIG posts new CIA agreement
On November 18, the OIG posted information on a Corporate Integrity Agreement with Steven Mendelsohn, M.D., Zwanger and Pesiri Radiology Group, LLC and Zwanger Radiology, P.C. of Lindenhurst, NY.