This week in Medicare updates–6/14/2017
End Stage Renal Disease (ESRD) Facilities: Filling Saline Syringes at the Patient Treatment Station
On June 2, the Centers for Disease Control and Prevention (CDC) issued a memorandum that ESRD facilities must follow aseptic technique when preparing and administering intravenous medications; including the filling of syringes with sterile saline for use during the dialysis procedure.
Effective date: June 2, 2017
Cleaning the End Stage Renal Disease (ESRD) station between patients Memorandum
On June 2, CMS issued a memorandum recommending that a dialysis station, in order to prevent cross contamination, be completely vacated by the previous patient before the ESRD staff may begin cleaning and disinfection of the station and set up for the next patient. CMS reiterates that patients should not be moved from the dialysis station until they are clinically stable.
Effective date: 30 days after issuance
Requirement to Reduce Legionella Risk in Healthcare Facility Water Systems to Prevent Cases and Outbreaks of Legionnaires’ Disease
On June 2, CMS issued a memorandum regarding prevention of Legionella. The bacterium Legionella can cause a serious type of pneumonia. Those at risk include persons who are at least 50 years old, smokers, or those with underlying medical conditions such as chronic lung disease or immunosuppression. Outbreaks have been linked to poorly maintained water systems in buildings with large or complex water systems including hospitals and long-term care facilities.
Effective date: June 2, 2017
Proposed Revision Requirements for Long-Term Care Facilities' Arbitration Agreements
On June 5, CMS issued proposed revisions to arbitration agreement requirements for long-term care facilities. These proposed revisions focus on transparency in the arbitration process, reduce unnecessary provider burden, and support residents' rights to make informed decisions about their care. Proposed revisions include the removal of prohibiting pre-dispute binding arbitration agreements, requiring that all binding arbitration agreements be written in plain language, and the requirement that the resident acknowledge that he or she understands the agreement.
New Guidance for Outpatient Facility Claims
On June 6, CMS released Special Edition MLN Matters SE17015 intended for both billers who submit HIPAA Accredited Standards Committee 837 X 12N institutional claims for outpatient hospital facility services to Medicare and those who submit claims to Medicare via Direct Data Entry, intended to reduce the incidence of receiving Return-to-Provider edits on incoming 837 outpatient hospital facility claims, as well as Direct Data Entry claims. CMS has indicated that it intends for two recent Return to Provider edits to apply to original claims and only to provider-initiated adjustment claims.
Effective date: August 7, 2017
Updated Important Message from Medicare and Updated Detailed Notice of Discharge Form
On June 7, CMS published updated Important Message from Medicare and Updated Detailed Notice of Discharge Forms. Instructions and forms can be found in the Downloads section of the CMS website.
New Common Working File Medicare Secondary Payer (MSP) Type for Set-Aside and No-Fault Arrangements
On June 8, CMS released an update to Transmittal R1857OTN to comply with the Government Accountability Office (GAO) final report Medicare Secondary Payer, Additional Steps Are Needed to Improve Program Effectiveness for Non-Group Health Plans (GAO 12-333), CMS will establish two new set-aside processes: a Liability Insurance Medicare Set-Aside Arrangement (LMSA), and a No-Fault Insurance Medicare Set-Aside Arrangement (NFMSA).
Effective date: October 1, 2017
Implementation Date: October 2, 2017
New Provider Self-Disclosure Settlements and Corporate Integrity Agreements
On June 8, the OIG posted information on new corporate integrity agreements with Fredericksburg Hospitalist group, LLC, of Fredericksburg, VA, and Ana M Gama, DDS, of Rialto, CA.
July 2017 Update of the Ambulatory Surgical Center (ASC) Payment System
On June 9, CMS released MLN Matters 10138, which relates to Transmittal 3788, dated June 2, 2017. The transmittal describes changes to and billing instructions for various payment policies implemented in the July 2017 ASC payment system update.
Effective date: July 1, 2017
Implementation date: July 3, 2017
Elimination of Routine Reviews Including Documentation Compliance Reviews and Instituting Three Medical Reviews
On June 9, CMS issued Transmittal 721 to instruct contractors to not perform routine reviews, including documentation compliance reviews, and creating three new kinds of reviews: Medical records reviews (i.e., complex reviews), automated reviews, and non-medical record reviews.
Effective date: July 11, 2017
Implementation date: July 11, 2017
Standardization of Demand Letter Language
On June 9, CMS issued a change to Transmittal 286 standardizing demand letter language in addition to clarifying and updating instructions to chapter 4, sections 20 through 20.2 of the Financial Management Manual.
Effective date: July 3, 2017
Implementation date: July 3, 2017
Screening for Hepatitis B Virus (HBV) Infection
On June 9, CMS published Transmittal 3793 and Transmittal 197, which rescind and replace Transmittals 195 and 3761, dated April 28, 2017. These transmittals address screening for HBV infection, which will be covered with the appropriate Food and Drug Administration (FDA)-approved laboratory tests, used consistently with FDA-approved labeling and in compliance with the Clinical Laboratory Improvement Act (CLIA) regulations.
Effective date: September 28, 2017
Implementation date: October 2, 2017 for design and coding; January 2, 2018 for testing and implementation