This week in Medicare updates–2/8/2017
Updated Editing of Professional Therapy Services
On January 27, CMS published Transmittal 1775 to identify new therapy CPT codes for physical and occupational therapy evaluations.
Effective date: January 1, 2017
Implementation date: July 3, 2017
Medicare Outpatient Observation Notice (MOON) Instructions
On January 27, CMS published Transmittal 3698, which rescinds and replaces Transmittal 3695, dated January 20, 2017, to update Section II of the transmittal (Changes in Manuals Instructions) to add new manual sections that were not included in the original final CR. There are no other changes.
CMS also published MLN Matters 9935 on the MOON instructions on January 24, 2017. Providers should use the MOON to inform Medicare beneficiaries when they are an outpatient receiving observation services and are not an inpatient of the hospital or critical access hospital.
Effective date: February 21, 2017
Implementation date: February 21, 2017
DMEPOS Competitive Bidding Round 2019 Announced
On January 31, CMS published a Press Release and Fact Sheet announcing plans to consolidate all rounds and areas included in the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program into a single round of competition--Round 2019. It also highlights several key updates to the DMEPOS Competitive Bidding Program.
ICD-10 Coding Revisions to National Coverage Determination (NCD)
On February 3, CMS posted Transmittal 1792, which rescinds and replaces Transmittal 1755, dated November 18, 2016, to make the multiple changes, including revisions to the following NCDs:
- NCD180.1: Add B MAC responsibility to requirement 8
- NCD100.1: Revise spreadsheet to replace truncated diagnosis codes with full translations
- NCD80.2: Revise spreadsheet and requirement 3 to clarify additions/deletions and FISS RCs
- NCD80.11: Revise spreadsheet and requirement 4 to correct FISS RCs to 59015/59016 and add B MAC responsibility
- NCD110.4: Add A/MAC responsibility, remove B/MAC responsibility in requirement 15 to deactivate FISS RC 31808/31835, and revise spreadsheet history
- NCD110.23: Revise spreadsheet to remove additional allogeneic PCS codes, add additional allogeneic PCS codes, remove MCS, add B/MAC responsibility to requirement 7
- NCD220.4: Clarify expired CPT codes in spreadsheet, add B/MAC responsibility to requirement 10
- NCD220.6.17: revise spreadsheet & requirement 11 to replace deleted HCPCS C9461 with A9515 effective 1/1/17, add dx D47.Z1 effective 10/1/15, add B/MAC responsibility
- NCD210.3: add B/MAC responsibility to requirement 9
- NCD40.7: add B/MAC responsibility to requirement 2
- NCD270.6: Remove FISS responsibility from requirement 14
Effective date: October 1, 2016
Implementation dates:
- March 3, 2017- A/B MAC local systems
- April 3, 2017 - FISS, MCS, CWF Shared systems
Extension of Payment Change for Group 3 Complex Rehabilitative Power Wheelchairs Accessories and Seat and Back Cushions under Section 16005 of the 21st Century Cures Act
On February 3, CMS posted Transmittal 3713 to provide instructions regarding the implementation of the 2017 fee schedule amounts based on the changes mandated by section 16005 of the 21st Century Cures Act.
Effective date: January 1, 2017
Implementation dates:
- April 3, 2017 - For VMS
- July 3, 2017 - For FISS
New Fields in the Fiscal Intermediary Shared System Inpatient and Outpatient Provider Specific Files (PFS)
On February 3, CMS posted Transmittal 3712 to implement a new a five-character field created to house the county code on the inpatient and outpatient PSF. Currently, for inpatient and outpatient claims, Medicare Administrative Contractors (MAC) apply the out migration adjustment to the wage index annually. CMS provides MACs with a list of counties eligible for the out migration adjustment, and MACs must manually compute a wage index for providers eligible for the out migration adjustment.
Effective date: July 3, 2017 - FY 2018 for the IPPS and for CY 2018 for the OPPS
Implementation date: July 3, 2017
Update for Additional ICD-10 Codes for the System Changes to Implement Section 231 of the Consolidated Appropriations Act Temporary Exception for Certain Severe Wound Discharges From Certain Long-Term Care Hospitals
On February 3, CMS posted Transmittal 1786 to include additional ICD-10 codes for the implementation of the temporary exception for certain wound care discharges from the site-neutral payment rate for certain Long-Term Care Hospitals.
Effective date: April 21, 2016
Implementation date: July 3, 2017
Qualified Medicare Beneficiary Indicator in the Medicare Fee-For-Service Claims Processing System
On February 3, CMS posted Transmittal 3715 to create an indicator of Qualified Medicare Beneficiary (QMB) status in the claims processing systems (i.e., CWF, FISS, MCS, and VMS). Beneficiaries enrolled in the QMB program are not liable to pay Medicare cost-sharing for all Medicare A/B claims. The new claims processing systems QMB indicator will trigger notifications to providers and to beneficiaries to reflect that the beneficiary is a QMB individual and lacks Medicare cost-sharing liability.
Effective date: October 2, 2017 for claims processed on or after this date
Implementation dates:
- July 3, 2017 - CWF: Implementation of BRs 9911.1, 9911.1.1, 9911.1.2, and 9911.1.3; Design only and draft trailer layout provided to SSMs for BR 9911.2.1;VMS, MCS: analysis, design, and coding; FISS: analysis and design
- October 2, 2017 - CWF: Implementation of remaining BRs; FISS, VMS, MCS: coding, testing, and implementation.
New Common Working File (CWF) Medicare Secondary Payer (MSP) Type for Liability Medicare Set-Aside Arrangements (LMSA) and No-Fault Medicare Set-Aside Arrangements (NFMSA)
On February 3, CMS posted Transmittal 1787 to identify the roles the A/B Medicare Administrative Contractors (MAC), Durable Medical Equipment MACs, shared systems, and CWF will have for creating LMSA or NFMSA records on CWF and processing MSP claims accordingly with an open set aside MSP record on CWF.
Effective dates:
- July 1, 2017 - MCS, VMS, FISS, and CWF Analysis and Design
- October 1, 2017 - MCS, VMS, FISS, and CWF Coding and Testing
Implementation date:
- July 3, 2017 - MCS, VMS, FISS, and CWF Analysis and Design
- October 2, 2017 - MCS, VMS, FISS, and CWF Coding and Testing
Revisions to State Operations Manual (SOM), Appendix C-Survey Procedures and Interpretive Guidelines for Laboratories and Laboratory Services
On February 3, CMS posted Transmittal 166 to reflect comments and recommendations from regional office and State Agency surveyors, professional and accrediting organizations, other HHS components, and a Government Accountability Office audit. Changes have also been made to include partial deletions of certain subsections affected and to reflect the recent publication of regulations and updates in technologies within the field of laboratory medicine. Standard level headings have been added to all D-tags for ease of use by surveyors.
Effective date: March 3, 2017
Implementation date: March 3, 2017
Change to Beneficiary Liability and Cost Report Days for Subclause (II) Long Term Care Hospitals (LTCH)
On February 3, CMS posted Transmittal 1791 to change how inpatient covered days are charged to the beneficiary's utilization of benefit days. Days of utilization will now be charged based upon actual days of coverage.
Effective date: January 1, 2017
Implementation date: July 3, 2017
Implementation of New Influenza Virus Vaccine Code
On February 3, CMS posted Transmittal 3711 to provide instructions for payment and Common Working File edits needed to include influenza virus vaccine code 90682 (Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use).
Effective date: July 1, 2017
Implementation date: July 3, 2017
Payment for Oxygen Volume Adjustments and Portable Oxygen Equipment- FISS
On February 3, CMS posted Transmittal 1785 to remind contractors of instructions located at section 130.6 of chapter 20 of the Medicare Claims Processing Manual (Pub.100-04), which provides information 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: July 3, 2017
Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure to Procedure (PTP) Edits, Version 23.1, Effective April 1, 2017
On February 3, CMS posted Transmittal 3708 regarding the normal quarterly update to the NCCI PTP edits. Since CMS no longer publishes a Mutually Exclusive edit file on its website, all active and deleted edits will appear in the single Column One/Column Two Correct Coding edit file. The edits previously contained in the Mutually Exclusive edit file are not being deleted but are being moved to the Column One/Column Two Correct Coding edit file.
Effective date: April 1, 2017
Implementation date: April 3, 2017
New “K” Code for Continuous Positive Airway Pressure Device Bundle
On February 3, CMS posted Transmittal 3710 regarding a new K code for Continuous Positive Airway Pressure (CPAP) device bundle, including CPAP device and all accessories, subject to Durable Medical Equipment (DME), Prosthetic, Orthotic and Supplies (DMEPOS) competitive bidding program in specified competitive bidding areas. The addition of the code will allow the DME Medicare Administrative Contractors to correctly adjudicate claims.
Effective date: April 1, 2017
Implementation date: April 3, 2017
Quarterly Update for the Durable Medical Equipment (DME), Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program (CBP) - April 2017
On February 3, CMS posted Transmittal 3702 regarding the quarterly update to the DME CBP files, which are revised to implement necessary changes to the HCPCS, ZIP code, Single payment amount, and Supplier files.
Effective date: April 1, 2017
Implementation date: April 3, 2017
HCPCS Codes Subject to and Excluded from Clinical Laboratory Improvement Amendments (CLIA) Edits
On February 3, CMS posted Transmittal 3701 to inform contractors about the new HCPCS codes for 2017 that are subject to and excluded from CLIA edits. CLIA regulations require a facility to be appropriately certified for each test performed.
Effective date: January 1, 2017
Implementation date: April 3, 2017
Changes to the National Coordination of Benefits Agreement (COBA) Crossover Process as a Result of the Social Security Number Removal Initiative (SSNRI)
On February 3, CMS posted Transmittal 3714 to outline the systems changes that are needed within the COBA Medicare claims crossover process to accommodate the Medicare Beneficiary Identifier (MBI), the focal point of CMS' SSNRI project.
Effective date: July 1, 2017
Implementation date: July 3, 2017