This week in Medicare updates–3/1/2017
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 14, CMS released MLN Matters 9966 to accompany Transmittal 3713 dated February 3, 2017. The MLN article provides 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
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 14, CMS released MLN Matters 9872 to accompany Transmittal 1786 dated February 3, 2017. The MLN article addresses the inclusion of 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 14, CMS released MLN Matters 9911 to accompany Transmittal 3715 dated February 3, 2017. The MLN article addresses the creation of an indicator of Qualified Medicare Beneficiary (QMB) status in the claims processing systems (i.e., CWF, FISS, MCS, and VMS). 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.
Change to Beneficiary Liability and Cost Report Days for Subclause (II) Long Term Care Hospitals (LTCH)
On February 14, CMS released MLN Matters 9912 to accompany Transmittal 1791 dated February 3, 2017. The MLN article addresses how inpatient covered days are charged to the beneficiary's utilization of benefit days.
Effective date: January 1, 2017
Implementation date: July 3, 2017
Payment for Oxygen Volume Adjustments and Portable Oxygen Equipment- FISS
On February 14, CMS released MLN Matters 9928 to accompany Transmittal 1785 dated February 3, 2017. The MLN article reminding 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
Instructions to Process Services Not Authorized by the Veterans Administration (VA) in a Non-VA Facility Reported With Value Code (VC) 42
On February 14, CMS released Transmittal 3718, which rescinds and replaces Transmittal 3635, dated October 28, 2016, to to add a business requirement for the Common Working File (CWF) to allow inpatient claims with value code 42 and condition code 26. All other information remains the same. CMS revised and published the related MLN Matters 9818 accordingly on February 17, 2017. The original billing instruction for service not authorized by the VA, as referenced in the transmittal, are contained in MLN Matters Article SE1517.
Effective date: October 1, 2013
Implementation date: April 3, 2017
Revision to State Operations Manual (SOM) Appendix PP
On February 17, CMS posted a Memorandum regarding the recent revision of the SOM Appendix PP in Transmittal 167, dated February 10, 2017. CMS will issue a subsequent version of Appendix PP with updated Interpretive Guidance and a re-ordering of F-Tags in the future. Only Phase 1 regulatory text is effective in this version of Appendix PP. Additional information about implementation of the final rule is also available on the CMS website.
Effective date: Immediately
Advance Care Planning (ACP) Implementation for Outpatient Prospective Payment System (OPPS) Claims
On February 21, CMS released MLN Matters 9862 to accompany Transmittal 1795 dated February 10, 2017. The MLN article addresses system changes necessary to process ACP services for OPPS claims.
Effective date: January 1, 2016
Implementation date: July 3, 2017
Preventing Hospice Notices of Election with Future Dates
On February 21, CMS released MLN Matters 9932 to accompany Transmittal R1799OTN dated February 17, 2017. The MLN article 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
ICD-10 Coding Revisions to National Coverage Determinations (NCD)
On February 23, CMS released MLN Matters 9982 to accompany Transmittal 1798 dated February 17, 2017. The MLN article addresses the 11th maintenance update of ICD-10 conversions and other coding updates specific to NCDs.
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
Public Meetings in 2017 for New Public Requests for Revisions to the Healthcare Common Procedure Coding System (HCPCS) Coding and Payment Determinations
On February 24, CMS published an Announcement in the Federal Register to announce the dates, time, and location of the HCPCS public meetings to be held in 2017 to discuss preliminary coding and payment determinations for all new public requests for revisions to the HCPCS.
Clarification of Payment Policy Changes for Negative Pressure Wound Therapy (NPWT) Using a Disposable Device and the Outlier Payment Methodology for Home Health Services
On February 24, CMS published Transmittal 233 to incorporate policies discussed in the 2017 Home Health Prospective Payment System Final Rule into the Medicare Benefit Policy Manual. The policies relate to payment for furnishing of NPWT using a disposable device as well as changes to the methodology used to calculate outlier payments to Home Health Agencies.
Effective date: January 1, 2017
Implementation date: March 27, 2017