This week in Medicare updates–3/29/2017
Billing for Advance Care Planning (ACP) Claims
On March 20, CMS released MLN Matters 10000 to accompany Transmittal 3739, which was released March 17. The transmittal provides billing instructions for ACP when furnished as an optional element of an Annual Wellness Visit.
Effective date: January 1, 2016
Implementation date: June 19, 2017
Changes to the Laboratory National Coverage Determination (NCD) Edit Software for July 2017
On March 20, CMS published MLN Matters 10036 to accompany Transmittal 3738, which was released March 17. The transmittal announces changes that will be included in the July 2017 quarterly release of the edit module for clinical diagnostic laboratory services.
Effective date: October 1, 2016
Implementation date: July 3, 2017
Alta Bates Medical Center Inaccurately Reported Wage Data, Resulting in Medicare Overpayments
On March 20, the OIG published a Report regarding Alta Bates Medical Center of Berkeley, California, which did not comply with all Medicare requirements for reporting wage data in its fiscal year 2010 Medicare cost report. The OIG estimates that Medicare overpaid the Medical Center $154,000 and overpaid 32 other hospitals in 2 core-based statistical areas a total of approximately $5.3 million in 2014.
Clarification of Patient Discharge Status Codes and Hospital Transfer Policies
On March 20, CMS rescinded MLN Matters SE0801, Clarification of Patient Discharge Status Codes and Hospital Transfer Policies.
Comment Request: Application for Enrollment in Medicare, the Medical Insurance Program, Application for Hospital Insurance Benefits for Individuals with End Stage Renal Disease, and more
On March 21, CMS published a Comment Request in the Federal Register regarding the following information collections:
- Application for Enrollment in Medicare, the Medical Insurance Program
- Application for Hospital Insurance Benefits for Individuals with End Stage Renal Disease
- Request for Termination of Premium Hospital and Supplementary Medical Insurance
- Collection of Prescription Drug Event Data from Contracted Part D Providers for Payment
- Medicaid Payment for Prescription Drugs—Physicians and Hospital Outpatient Departments Collecting and Submitting Drug Identifying Information to State Medicaid Programs
- Request for Retirement Benefit Information
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 March 21, CMS published a comment request in the Federal Register regarding a further delay of the effective date for the Advancing Care Coordination Through EPM; Cardiac Rehabilitation Incentive Payment Model; and changes to the CJRM rule published in the January 3, 2017 Federal Register. The delay moves the effective date from March 21, 2017 until May 20, 2017 and delays the applicability date of the regulations at 42 CFR part 512 from July 1, 2017 to October 1, 2017 and effective date of the specific CJR regulations itemized in the Dates section from July 1, 2017 to October 1, 2017. Comments are being sought regarding the appropriateness of this delay, as well as a further applicability date delay until January 1, 2018.
New Civil Monetary Penalty
On March 22, the OIG published information on a Civil Monetary Penalties law violation by Vinod Sharma, MD, a Michigan physician and pain management specialist, who agreed to be excluded from participation in Medicare and the State healthcare programs for a period of three years under following a referral to OIG by Kepro. The OIG alleged that Dr. Sharma failed to sufficiently document his response to the results of urine drug screenings and any discussions he had with patients regarding the urine drug screening results when these patients tested positive for illicit drugs; tested positive for controlled and noncontrolled substances not prescribed by Sharma; or tested negative for controlled substances Sharma prescribed.
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; Corrections
On March 22, CMS published a Final Rule Correction in the Federal Register to correct multiple technical errors in the addenda to the final rule published in the November 15, 2016, Federal Register, “Medicare Program; 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.”
Effective date: March 21, 2017; correction is applicable beginning January 1, 2017.
FISS Implementation of the Restructured Clinical Lab Fee Schedule (CLFS)
On March 23, CMS published Transmittal 3740, which rescinds and replaces Transmittal 3653, dated November 10, 2016, to revise business requirement 1.2, removing the decimal point in the rate field and indicating which digits are dollars and cents to make the new CLFS consistent with other pricing files. Attachment CLFS File Layout-Text File has also been removed. CMS revised MLN Matters 9837 accordingly.
Effective date: January 1, 2018
Implementation date: July 3, 2017
Denial of Home Health Payments When Required Patient Assessment Is Not Received – Additional Information
On March 24, CMS published MedLearn Matters Special Edition 17009 reminding providers that CMS has directed MACs 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. CMS also provides further information to assist home health agencies in avoiding problems with these Medicare requirements.
Effective date: April 1, 2017
Implementation date: April 3, 2017
Advanced Provider Screening (APS) Phase 1 Go-Live
On March 24, CMS released Transmittal 1808 to initiate the first phase of of APS automated criminal screening.
Effective date: May 15, 2017
Implementation date: May 15, 2017
Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Order Requirements for Changing Suppliers
On March 24, CMS released Transmittal 705 to instruct contractors to accept timely orders and medical documentation, regardless of whether the supplier received the documentation directly from the beneficiary’s eligible practitioner or from another transferring supplier.
Effective date: April 24, 2017
Implementation date: April 24, 2017