This week in Medicare updates–5/3/2017
Electronic Staffing Submission - Payroll-Based Journal Update
On April 21, CMS released a Memorandum regarding the mandatory staffing data submission for long-term care facilities through the Payroll-Based Journal, which began July 1, 2016. CMS is reminding that they have until the 45th day after the end of each quarter to submit data. The Nursing Home Compare website now reflects whether providers have submitted data by the required deadline. Additionally, providers that have not submitted any data for two consecutive deadlines will have their overall and staffing star ratings suppressed. CMS is also updating the data submission requirements related to hire and termination dates and converting three job codes as optional for submission.
Update to Pub. 100-08, Chapter 15
On April 25, CMS published Transmittal 711, which rescinds and replaces Transmittal 710, dated April 14, 2017, to remove section 15.4.1.4 (Federally Qualified Health Centers) from the list of manual revisions in Section II of the transmittal and add section 15.4.6.1 (Diabetes Self-Management Training).
Effective date: May 15, 2017
Implementation date: May 15, 2017
Implementation of New Influenza Virus Vaccine Code
On April 26, CMS released MLN Matters 9876, which was revised due to the update of Transmittal 3754, which was released April 21. 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
MIPS Participation Status Letter
On April 27, CMS released an email notification to let practices know which clinicians need to take part in the Merit-based Incentive Payment System (MIPS), an important part of the new Quality Payment Program (QPP). Practices will receive a letter from their Part B Medicare Administrative Contractor in May; the letter will provide the participation status of each MIPS clinician associated with the practice’s Taxpayer Identification Number (TIN).
Clinicians should participate in MIPS in the 2017 transition year if they:
- Bill more than $30,000 in Medicare Part B allowed charges a year and
- Provide care for more than 100 Part B-enrolled Medicare beneficiaries a year
Improvements to the Adjudication Process of Serial Claims
On April 27, CMS published Special Edition MLN Matters 17010 to inform Durable Medical Equipment (DME) suppliers of the Serial Claims initiative, in which CMS is implementing changes to improve the processing and adjudication of Medicare Fee-For-Service (FFS) recurring (or serial) claims for capped rental items and certain Inexpensive and Routinely Purchased (IRP) items. This initiative began in April 2017.
Prospective Payment System (PPS) and Consolidated Billing for Skilled Nursing Facilities for FY 2018, SNF Value-Based Purchasing Program, SNF Quality Reporting Program, Survey Team Composition, and Proposal to Correct the Performance Period for the NHSN HCP Influenza Vaccination Immunization Reporting Measure in the ESRD QIP for PY 2020
On April 27, CMS published the FY 2018 Skilled Nursing Facilities PPS and Consolidated Billing Proposed Rule. Major provisions of the proposed rule include proposals for the SNF Value-Based Purchasing Program and the SNF Quality Reporting Program. The proposed rule also includes a Request for Information (RFI), a proposal for the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP). View the associated Fact Sheet. Comments are due June 26, 2017.
FY 2018 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements
On April 27, CMS published the FY 2018 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements Proposed Rule, which would update the hospice wage index, payment rates, and cap amount for 2018. The rule solicits comments regarding the source of clinical information for certifying terminal illness and proposes changes to the Hospice Quality Reporting Program (Hospice QRP), including proposing new quality measures utilizing data collected in the Hospice CAHPS Survey. It also discusses new quality measure concepts under consideration for future years, solicits feedback on an enhanced data collection instrument, and describes plans to publicly display quality measure data via the Hospice Compare website in 2017. View the associated Fact Sheet. Comments are due June 26, 2017.
FY 2018 Inpatient Rehabilitation Facility Prospective Payment System Proposed (IRF PPS) Rule
On April 27, CMS published the FY 2018 Inpatient Rehabilitation Facility Proposed Rule outlining proposed fiscal year (FY) 2018 Medicare payment policies and rates for the IRF PPS and the IRF Quality Reporting Program (IRF QRP). For the IRF QRP, CMS is proposing to replace the current pressure ulcer measure with an updated version of that measure. In addition, CMS is proposing to remove the All-Cause Unplanned Readmission measure. CMS is also proposing to begin publicly reporting six new measures for display on the IRF Compare Website by fall 2018. CMS also released a Request for Information for feedback on the Medicare Program. View the proposed rule’s associated Fact Sheet. Comments are due June 27, 2017.
Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities: Revisions to Case-mix Methodology
On April 27, CMS published the Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities: Revisions to Case-mix Methodology Proposed Rule to solicit public comments on potential options for revising certain aspects of the existing SNF PPS payment methodology to improve its accuracy based on the results of CMS’ SNF Payment Models Research (SNF PMR) project. CMS is especially seeking comments on the possibility of replacing the SNF PPS’ existing case-mix classification model, the Resource Utilization Groups, Version 4 (RUG-IV), with a new model, the Resident Classification System, Version I (RCS-I). View the associated Fact Sheet. Comments are due June 26, 2017.
New Corporate Integrity Agreement
On April 27, the OIG posted information on two new Corporate Integrity Agreements:
- Braden Partners, LP, and Pacific Pulmonary Services of Novato, CA
- Norman A. Brooks, MD, and Norman A. Brooks, MD, Inc. and The Skin Cancer Medical Center of Encino, CA
Medicare Compliance Review of the University of Arkansas for Medical Sciences Medical Center for 2013 and 2014
On April 28, the OIG published a Report on its Medicare compliance review of the University of Arkansas for Medical Sciences Medical Center for 2013 and 2014. According to the OIG review, the hospital did not fully comply with Medicare billing requirements for 16 of the 70 inpatient claims reviewed. The OIG estimates that the hospital received overpayments of at least $279,000 for claims paid during 2013 and 2014. The hospital complied with Medicare billing requirements for all 60 outpatient claims reviewed.
Qualified Medicare Beneficiary Indicator in the Medicare Fee-For-Service Claims Processing System
On April 28, CMS published Transmittal 3764, which rescinds and replaces Transmittal 3715, dated February 3, 2017, to revise business requirement 9911.5 to refer to the claim rather than the line. All other information remains the same.
Effective date: October 2, 2017
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.
Reason Codes 36233 and 36330 Bypass for Claims Submitted on the 72x Type of Bill for Services Provided to Beneficiaries with Acute Kidney Injury (AKI) and edits related to not separately payable drugs
On April 28, CMS published Transmittal 1835 to add reason codes 36233 and 36330 to the list of codes to bypass for Acute Kidney Injury (AKI) claims and to provide edits related to not separately payable drugs.
Effective date: January 1, 2017
Implementation date: October 2, 2017
New Physician Specialty Code for Advanced Heart Failure and Transplant Cardiology, Medical Toxicology, and Hematopoietic Cell Transplantation and Cellular Therapy
On April 28, CMS published Transmittal 3762 and Transmittal 283 regarding two newly established physician specialty codes for Advanced Heart Failure and Transplant Cardiology (C7), Medical Toxicology (C8), and Hematopoietic Cell Transplantation and Cellular Therapy (C9).
Effective date: October 1, 2017
Implementation date: October 2, 2017
Qualified Medicare Beneficiary Indicator in the Medicare Fee-For-Service Claims Processing System
On April 28, CMS published Transmittal 3760, which rescinds and replaces Transmittal 3715, dated February 3, 2017, to revise business requirement 9911.5 to refer to the claim rather than the line.
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.
Payment for Moderate Sedation Services Furnished with Colorectal Cancer Screening Tests
On April 28, CMS published Transmittal 3763 to ensure accurate program payment for moderate sedation services furnished in conjunction with screening colonoscopy services for which the beneficiary should not be charged the coinsurance or deductible. The coinsurance and deductible for these services are waived, but due to coding changes and additions to the Medicare Physician Fee Schedule Database, the payments for CY 2017 would be inaccurate without this transmittal.
Effective date: January 1, 2017
Implementation date: October 2, 2017
Implementation of Section 1557 for Medicare Redetermination Notices by Adding a Notice and Tagline Sheet
On April 28, CMS published Transmittal 1839 to instruct all Medicare Administrative Contractors (MAC), including Part A/B MACs, Home Health and Hospice MACs, and Durable Medical Equipment MACs, to add a new last page to the Medicare Redetermination Notices.
Effective date: October 1, 2017
Implementation date: October 2, 2017
Implementing the remittance advice messaging for the 20-hour weekly minimum for Partial Hospitalization Program services.
On April 28, CMS published Transmittal 1833 to implement remittance advice messaging that conveys supplemental and educational information to the provider submitting claims for Partial Hospitalization Program services where the patient did not receive the minimum 20 hours per week of therapeutic services his plan of care indicates is required, on claims with line item date of service (LIDOS) on or after October 1, 2017.
Effective date: October 1, 2017
Implementation date: October 2, 2017
Screening for Hepatitis B Virus (HBV) Infection national coverage determination (NCD)
On April 28, CMS published Transmittal 195 and Transmittal 3761 regarding CMS’ determination that, effective September 28, 2016, screening for HBV infection will be covered with the appropriate FDA approved/cleared laboratory tests, used consistent with FDA-approved labeling and in compliance with the Clinical Laboratory Improvement Act (CLIA) regulations.
Effective date: September 28, 2016
Implementation dates: October 2, 2017 - for design and coding; January 1, 2018 - Testing and Implementation
Introductory Letters for Suppliers and Providers Related to the Prior Authorization for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
On April 28, CMS published Transmittal 1831 to alert the Medicare Administrative Contractors (MAC) that stakeholder education, in the form of the attached Introductory Letters, shall be sent to the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers and pertinent physicians/practitioners as described in the transmittal.
Effective date: May 30, 2017
Implementation date: May 30, 2017