This week in Medicare updates–4/12/2017

April 11, 2017
Medicare Insider

New 2017 Inpatient Pricer Released

On March 31, CMS released the Inpatient Prospective Payment System (IPPS) PC Pricer for claims dated October 1, 2016, to September 30, 2017. The PPS Pricer software is released on a quarterly basis. In addition, CMS has also updated its IPPS User Manual accordingly.

 

Decision Memo for Hyperbaric Oxygen (HBO) Therapy (Section C, Topical Oxygen) (CAG-00060R)

On April 3, CMS published a Decision Memo for HBO therapy after receiving a reconsideration request to remove the coverage exclusion of Continuous Diffusion of Oxygen Therapy (CDO) from NCD Manual 20.29, Section C. After examining the evidence, CMS has decided that no National Coverage Determination is appropriate at this time concerning the use of topical oxygen for the treatment of chronic wounds and will amend NCD 20.29 by removing Section C, Topical Application of Oxygen. Medicare coverage of topical oxygen for the treatment of chronic wounds will be determined by the local contractors.

 

2018 Medicare Advantage and Medicare Part D Rate Announcement and Call Letter, and Request for Information

On April 3, CMS published a Fact Sheet and Press Release regarding the release of final updates to the Medicare Advantage and Part D programs through the 2018 Rate Announcement and Call Letter posted February 1, 2017. CMS accepted comments on all proposals through March 3, 2017. In addition, CMS has also released a Request for Information to welcome continued feedback on Medicare Advantage and Part D.

 

Conditions of Participation (CoP) for Home Health Agencies; Delay of Effective Date

On April 3, CMS published a Proposed Rule in the Federal Register that would delay the effective date for the CoP for Home Health Agencies final rule published January 13, 2017. The current effective date for the final rule is July 13, 2017, which the proposed rule would delay for an additional 6 months until January 13, 2018.

 

New Waived Tests

On April 3, CMS revised MLN Matters 9956, to accompany Transmittal 3741, published March 30, 2017, which updated an incorrect CPT drug test code from 80305 to 80305QW.

Effective date: April 1, 2017

Implementation date: April 3, 2017

 

Florida Neurologist Excluded

On April 6, OIG announced that it has excluded Sean Orr, MD, a Florida neurologist, for defaulting on his payment obligations under a Settlement Agreement with the Department of Justice and OIG. Orr previously entered into the Agreement for knowingly misdiagnosing certain patients with various neurological disorders, such as multiple sclerosis, which caused claims to be submitted to federal healthcare programs for medically unnecessary items and services. The terms provided that Dr. Orr would make an initial upfront payment plus additional payments over a five-year period.

 

Correction: Hospital Outpatient Prospective Payment (OPPS) and Ambulatory Surgical Center (ASC) 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 April 6, CMS published a Correction in the Federal Register regarding the OPPS and ASC payment systems and Quality Reporting Programs; Organ Procurement Organization Reporting and Communication; Transplant Outcome Measures and Documentation Requirements; EHR Incentive Programs; etc., final rule with comment period published November 14, 2016. The correction addresses a technical error in the rule related to the demonstration of meaningful use criteria under § 495.40.

 

New Corporate Integrity Agreements

On April 7, the OIG announced new Corporate Integrity Agreements with the following providers:

  • Ravi Sharma, MD, of Land O'Lakes, Florida
  • Millicent Francis-Lane, MD, of Union County Women's Care, PA, in Monroe, North Carolina

 

July 2017 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files

On April 7, CMS published Transmittal 3746 to supply contractors with the ASP and not otherwise classified (NOC) drug pricing files for Medicare Part B drugs on a quarterly basis.

Effective date: July 1, 2017

Implementation date: July 3, 2017