This week in Medicare updates–4/26/2017

April 25, 2017
Medicare Insider

Notice of Proposed Regulation Changes for Accrediting Organizations (AO) Transparency and Termination Notices

On April 14, CMS published a Memorandum regarding the 2018 IPPS proposed rule. CMS proposed changes within the rule for public comment, including a requirement for AOs with CMS-approved accreditation programs to post survey reports, as well as changes in termination notices for and Ambulatory Surgical Centers (ASC), Federally Qualified Health Centers (FQHC), Rural Health Clinics (RHC) and Organ Procurement Organizations (OPO), which are discussed further in the Memorandum.


Update to Pub. 100-08, Chapter 15

On April 14, CMS published Transmittal 710 to make several revisions to Chapter 15 of the Medicare Program Integrity Manual. The transmittal updates general information for provider enrollment regarding payment arrangements for new and old owners undergoing a change of ownership, site visit requirements for providers that render services solely in patient’s homes, the process to follow when the Regional Office issues a tie-out notice to involuntarily terminate a provider, file maintenance requirements, and clarification of certification statement signature requirements.

Effective date: May 15, 2017

Implementation date: May 15, 2017


Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure to Procedure (PTP) Edits, Version 23.2, Effective July 1, 2017

On April 14, CMS published Transmittal 3748  and MLN Matters 10082 with the normal update to the NCCI PTP  edits. Version 23.2 will include all previous versions and updates from January 1, 1996, to the present.

CMS no longer publishes a Mutually Exclusive edit file on its website for either practitioner or outpatient hospital services, since all active and deleted edits will appear in the single Column One/Column Two Correct Coding edit file on each website. The edits previously contained in the Mutually Exclusive edit file were not deleted but were moved to the Column One/Column Two Correct Coding edit file.

Effective date: July 1, 2017

Implementation date: July 3, 2017


Payment for Moderate Sedation Services

On April 14, CMS published Transmittal 3747 and MLN Matters 10001 to clarify existing Medicare Claims Processing Manual language found in Chapter 12 (Physicians/Nonphysician Practitioners), Sections 50 and 140, to bring it in line with current payment policy for moderate sedation and anesthesia services.

Effective date: January 1, 2017

Implementation date: May 15, 2017


Rural Community Hospital Demonstration

On April 17, CMS published a Fact Sheet regarding the Rural Community Hospital Demonstration Program. Section 15003 of the 21st Century Cures Act, enacted December 13, 2016, required another 5-year extension period for the demonstration, allowing for hospitals currently participating as of the last day of the initial 5-year period or as of December 30, 2014, to participate in this second extension period unless the hospital elects to discontinue. Section 15003 also requires  a solicitation for applications to select additional hospitals to participate in the demonstration program for this second 5-year extension period so long as the maximum number of 30 hospitals stipulated by the ACA is not exceeded. The due date for applications is May 17, 2017.


Next Generation Accountable Care Organization (ACO) – All Inclusive Population Based Payment (AIPBP) Implementation

On April 20, CMS published Special Edition MLN Matters 17011 to remind providers of the implementation of the AIPBP payment mechanism for participating ACOs. All participating providers will continue to submit fee-for-service (FFS) claims to CMS, which will fully adjudicate the claims, but will not make payment to providers who have agreed to participate in AIPBP except for add-on payments for inpatient hospitals (i.e., operating outlier payments, operating disproportionate share hospital payments, operating indirect medical education payments, Medicare new technology payments, and Islet isolation cell transplantation payments). All AIPBP-participating providers will receive a 100% reduction to their claims if they see an aligned beneficiary, unless that aligned beneficiary has opted out of medical claims data sharing with the ACO or if the claim is for substance abuse-related services. If an AIPBP-participating provider sees a beneficiary not aligned to an ACO, they would not receive the reduction.

Effective date: January 1, 2017

Implementation date: January 3, 2017


Implementation of New Influenza Virus Vaccine Code

On April 21, CMS published Transmittal 3754, which rescinds and replaces Transmittal 3754, dated, April 21, 2017, to remove business requirement 9876.11. The transmittal provides instructions for payment and CWF edits to be updated 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) for claims with dates of service on or after July 1, 2017.

Effective date: July 1, 2017

Implementation date: July 3, 2017


Two New K Codes for Therapeutic Continuous Glucose Monitors

On April 21, CMS published Transmittal 3751 to facilitate implementation of  CMS Ruling 1682-R, which was issued on January 12, 2017, that  the following two codes for therapeutic continuous glucose monitors will be added to the HCPCS code set effective July 1, 2017. This will enable the Durable Medical Equipment (DME) Medicare Administrative Contractors (MAC) to correctly adjudicate claims.

Effective date: July 1, 2017

Implementation date: July 3, 2017


Medicare Quality Improvement Organization (QIO) Manual Chapter 16 – “Healthcare Quality Improvement Program” update

On April 21, CMS published Transmittal 30 to update the QIO Manual language consistent with current program operations.

Effective date: April 21, 2017

Implementation date: April 21, 2017