This week in Medicare updates–5/17/2017
Comment Request: Disclosures Required of Certain Hospitals and Critical Access Hospitals Regarding Physician Ownership
On May 10, CMS posted a Comment Request in the Federal Register regarding the information collection “Disclosures Required of Certain Hospitals and Critical Access Hospitals (CAH) Regarding Physician Ownership.” The Comment Request relates to the mandatory third-party disclosures certain hospitals and physicians must make to their patients disclosing whether the hospital is physician-owned and, if so, the names of the physician owners.
New Waived Tests
On May 12, CMS published Transmittal 3771 to inform contractors of new Clinical Laboratory Improvement Amendments of 1988 (CLIA) waived tests approved by the Food and Drug Administration. There are 12 new waived complexity tests.
Effective date: January 1, 2017
Implementation date: July 3, 2017
Changes to the Payment Policies for Reciprocal Billing Arrangements and Fee-For-Time Compensation Arrangements (formerly “Locum Tenens Arrangements”)
On May 12, CMS published Transmittal 3774 to:
- Implement section 16006 of the 21st Century Cures Act, which allows outpatient physical therapy services furnished by physical therapists in a health professional shortage area (HPSA), a medically underserved area (MUA), or in a rural area to be billed under reciprocal billing and fee-for-time compensation arrangements in the same manner as physicians bill effective no later than June 13, 2017.
- Update the Medicare Claims Processing Manual (Pub. 100-04), chapter 1, sections 30.2.1; 30.2.10; 30.2.11; 30.2.13; and 30.2.14 by changing “Carriers” to “A/B MACs Part B” and removing all references to “UPIN” since the terms “carriers” and “UPIN” are obsolete.
- Update sections 30.2.10 and 30.2.11 of the Medicare Claims Processing Manual to clarify that when a regular physician or physical therapist is called or ordered to active duty as a member of a reserve component of the Armed Forces for a continuous period of longer than 60 days, payment may be made to that regular physician or physical therapist for services furnished by a substitute under reciprocal billing arrangements or fee-for-time compensation arrangements throughout that entire period.
Effective date: June 13, 2017
Implementation date: June 13, 2017
Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - July CY 2017 Update
On May 12, CMS published Transmittal 3772 to amend the payment files issued to contractors based upon the CY 2017 Medicare Physician Fee Schedule Final Rule with the July 2017 update. Note the attachment for a summary of changes, including new HCPCS and CPT codes.
Effective date: January 1, 2017
Implementation date: July 3, 2017
April Quarterly Update for 2017 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule
On May 12, CMS published the revised MLN Matters 9988, which accompanies Transmittal 3768, published May 5. The transmittal rescinds and replaces Transmittal 3729, dated March 3, 2017, to delete example text in the policy section.
Effective date: April 1, 2017
Implementation date: April 3, 2017
Implementation of Modifier -CG for Type of Bill 72x
On May 12, CMS published Transmittal 1849 to implement modifier -CG, which identifies non-medically justified dialysis treatments. In order to accurately capture all treatments provided to a beneficiary, CMS is implementing a new modifier -CG (Policy Criteria Applied for the 72x type of bill (TOB) when used in the billing of hemodialysis treatments for patients with ESRD in excess of the 13 or 14 monthly allowable treatments). Append the modifier to the claim line for the date of service associated with the excess treatment.
CMS pays the full ESRD PPS base rate for all training treatments (condition code 73 or 87) even when they exceed 3 times per week, with a limit of 25 sessions. If medical justification is present without modifier CG, the claim line should pay separately.
Effective date: October 1, 2017
Implementation date: October 2, 2017
Common Working File (CWF) to reject Provider Queries containing Health Insurance Claim Numbers (HICN) starting with '9'
On May 12, CMS published Transmittal 1847 to to reject CWF Provider Queries (ELGA, ELGH, HIQA, HIQH, and HUQA) for Medicare eligibility data containing HICNs starting with “9”, as Medicare beneficiary HICNs starting with “9” are invalid.
Effective date: October 1, 2017
Implementation date: October 2, 2017
Suppression of G9678 (Oncology Care Model Monthly Enhanced Oncology Services) Claims OCM Beneficiary Medicare Summary Notice
On May 12, CMS published Transmittal 172 to suppress all G9678 (Oncology Care Model Monthly Enhanced Oncology Services) claims from the Medicare Summary Notice, including the billing code, HCPCS service description, claim lines, and all other content elements related to all G9678 codes.
Effective date: October 1, 2017
Implementation date: October 2, 2017