This week in Medicare updates–2/22/2017
OIG reports Settlement Agreements for alleged EMTALA violations
On February 14, the OIG released information regarding Covenant Medical Center in Waterloo, Iowa, which entered into a $100,000 Settlement Agreement with OIG on January 17, 2017. The agreement resolves allegations of a violation of the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide an appropriate psychiatric screening examination or stabilizing treatment for three patients who presented to the ED when an on-call psychiatrist was available.
In addition, on January 10, 2017, Cape Fear Medical Center in Fayetteville, North Carolina, entered into a $40,000 settlement agreement with OIG, resolving allegations that it violated EMTALA when it failed to provide an adequate medical screening examination and stabilizing treatment for a woman who presented to Cape Fear's ED in labor with her third child.
Processing Services Not Authorized by the Veterans Administration (VA) in a Non-VA Facility Reported With Value Code (VC) 42
On February 14, CMS published Transmittal 3178, which rescinds and replaces Transmittal 3635, dated October 28, 2016, to add a business requirement for CWF to allow inpatient claims with value code 42 and condition code 26.
Effective date: October 1, 2013
Implementation date: April 3, 2017
Quarterly Update to the Medicare Physician Fee Schedule (MPFS) Database - April CY 2017 Update
On February 15, CMS published Transmittal 3719, amending payment files issued to contractors based upon the CY 2017 MPFS Final Rule. This Recurring Update Notification applies to Pub. 100-04, Medicare Claims Processing Manual, Chapter 23, Section 30.1.
Effective date: January 1, 2017
Implementation date: April 3, 2017
Advancing Care Coordination Through Episode Payment Models (EPM); Cardiac Rehabilitation Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model (CJRM); Delay of Effective Date
On February 17, CMS published a Notice in the Federal Register regarding a delay in the effective date of the Advancing Care Coordination through EPMs; Cardiac Rehabilitation Incentive Payment Model; and Changes to the CJRM. accordance with the memorandum of January 20, 2017, from the Assistant to the President and Chief of Staff, “Regulatory Freeze Pending Review,” this action delays for 60 days from the date of the memorandum the effective date of the rule.
OIG Online Portfolio: Drug Pricing and Reimbursement
On February 17, the OIG published an Online Portfolio: Drug Pricing and Reimbursement, a collection of the OIG’s work since at least 2010 related to drug pricing and reimbursement in HHS programs. The portfolio features planned work, completed reports, industry guidance, and enforcement actions and will be updated periodically.
Provider Reimbursement Manual Part 2, Provider Cost Reporting Forms and Instructions, Chapter 29, Form CMS-222-92
On February 17, CMS published Transmittal 13 regarding updates to Chapter 29, Independent Rural Health Clinic (RHC)/Freestanding Federally Qualified Health Centers (FQHC) Cost Report (Form CMS-222-92) to reflect clarifications and corrections to existing instructions. For cost reporting periods beginning on or after October 1, 2014, Freestanding FQHCs are required to file using the Freestanding FQHC Cost Report (Form CMS-224-14), not the Independent (RHC)/Freestanding FQHC Cost Report (Form CMS-222-92).
Effective date: September 30, 2016
Episode Payment Model Operations
On February 17, CMS published Transmittal 169 regarding the additional set of episode payment models (EPM) similar to the CJR Model, as set forth in the December 2016, final rule. The new EPMs will focus on acute myocardial infarction (AMI), coronary artery bypass graft (CABG), and surgical hip and femur fracture treatment (SHFFT), most frequently hip pinning. These models will begin in 2017 and run for 5 performance years.
Effective date: July 1, 2017
Implementation date: July 3, 2017
ICD-10 Coding Revisions to National Coverage Determinations (NCD)
On February 17, CMS published Transmittal 1798, regarding the 11th maintenance update of ICD-10 conversions and other coding updates specific to NCDs. These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received.
Effective date: July 1, 2017 - Unless otherwise noted in individual NCDs
Implementation date: March 20, 2017 - A/B MAC Local Edits; July 3, 2017 - Shared System Edits
Preventing Hospice Notices of Election with Future Dates
On February 17, CMS published Transmittal 1799, which addresses the fact that there are future date edits for statement dates on notices, but they exclude notice type of bills. This change prevents future dates from being accepted in the admission and from date fields of a hospice notice.
Effective date: July 1, 2017
Implementation date: July 3, 2017
Quality Payment Program awards for small practices
On February 17, CMS published a Press Release announcing that it has awarded approximately $20 million to 11 organizations for the first year of a five-year program to provide on-the-ground training and education about the Quality Payment Program for clinicians in individual or small group practices of 15 clinicians or fewer. The local community-based organizations will provide hands-on training to help small practices, especially those in historically under-resourced areas including rural areas, health professional shortage areas, and medically underserved areas.