This week in Medicare updates–6/21/2017
Medicare Paid Hundreds of Millions in Electronic Health Record (EHR) Incentive Payments That Did Not Comply With Federal Requirements
On June 12, the OIG published a Report regarding payments CMS made to eligible professionals (EP) that were not always in accordance with federal requirements. The OIG estimates that CMS inappropriately paid $729.4 million (12% of the total) in incentive payments to EPs who did not meet meaningful use requirements. These errors occurred because sampled EPs did not maintain support for their attestations. CMS conducted minimal documentation reviews, leaving the self-attestations of the EHR program vulnerable, according to the OIG.
2016 Performance Data for the Senior Medicare Patrol Projects
On June 13, the OIG published a Report regarding performance data for the Senior Medicare Patrol (SMP) projects, which recruit and train retired professionals and other senior citizens to recognize and report healthcare fraud. For 2016, the projects reported $163,904 in cost avoidance on behalf of Medicare, Medicaid, beneficiaries, and others. Savings to beneficiaries and others totaled $53,449. Expected Medicare recoveries totaled $2,672. Two specific projects provided information that resulted in settlements totaling an additional $9.2 million in expected Medicare recoveries. The projects reported significantly lower expected Medicare recoveries ($2,672, down from $2.5 million) compared to 2015.
Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities (SNF): Revisions to Case-Mix Methodology - Comment Period Extension
On June 14, CMS published a Comment Period Extension in the Federal Register regarding the proposed rule “Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities: Revisions to Case-mix Methodology” published May 4, 2017. Comments are now due August 25, 2017.
Comment Request: Virtual Groups for Merit-Based Incentive Payment System (MIPS)
On June 14, CMS published a Comment Request in the Federal Register regarding the Virtual Groups for Merit-Based Incentive Payment System (MIPS) information collection. To help support small practices and practices in rural areas and provide them with additional flexibility, CMS has created a virtual group reporting option starting with the 2018 MIPS performance period. Comments are due August 14, 2017.
OIG Work Plan Updates
On June 15, the OIG published information about updates to its Work Plan. To enhance transparency around OIG’s continuous work planning efforts, the OIG will update its Work Plan website monthly and be web-based, effective immediately. The monthly update includes the addition of newly initiated Work Plan items, which can be found on the Recently Added Items page; completed items will be removed. New reports can be found on OIG’s What’s New page.
5 Ways for Healthcare Providers to Get Ready for New Medicare Cards
On June 15, CMS published an article, “5 Ways for Healthcare Providers to Get Ready for New Medicare Cards” via its Open Door Forum listserv for readers to share further in an effort to educate others about the removal of Social Security numbers from Medicare cards. Additional information is available at cms.gov/Medicare/SSNRI/Providers/Providers.html.
Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Pricer Update FY 2018
On June 16, CMS published Transmittal 3796 to provides information on the updates to the payment rates used under the PPS for SNFs for FY 2018.
Effective date: October 1, 2017
Implementation date: October 2, 2017
Updates in the Fiscal Intermediary Shared System (FISS) Inpatient and Outpatient Provider Specific Files (PSF)
On June 16, CMS published Transmittal 3795 to describe changes to Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS) payment policies to be implemented in the upcoming final rules. Instructions for Medicare Administrative Contractors (MAC) are forthcoming in associated transmittals.
Effective date: October 1, 2017 - For IPPS; January 1, 2018 - For OPPS
Implementation date: October 2, 2017 - For IPPS; January 2, 2018 - For OPPS
Annual ICD-10-CM Code Update
On June 16, CMS published Transmittal 3799 to provides the Medicare contractors with the annual ICD-10-CM updates. There are 360 new, 142 deleted, and 226 revised diagnosis codes in the final 2018 update posted to CMS’ website June 13. The final 2018 ICD-10-CM codes include 322 more changes than what was included in the April inpatient prospective payment system (IPPS) proposed rule.
Effective date: October 1, 2017
Implementation date: October 2, 2017
Medicare Benefit Policy Manual, Chapter 10, Ambulance Locality and Advanced Life Support (ALS) Assessment Revisions
On June 16, CMS published Transmittal 236 to provide clarifications on the definitions for locality and ground ambulance services for ALS assessment. CMS is revising the Medicare Benefit Policy Manual to clarify that Medicare Administrative Contractors (MAC) have the discretion to define locality in their service areas. The transmittal also clarifies that when an ALS assessment is performed, the services will be covered at the ALS emergency level if medically necessary and all other coverage requirements are met.
Effective date: September 18, 2017
Implementation date: September 18, 2017
Changes to the Laboratory National Coverage Determination (NCD) Edit Software for October 2017
On June 16, CMS published Transmittal 3797 to announce the changes that will be included in the October 2017 quarterly release of the edit module for clinical diagnostic laboratory services.
Effective date: October 1, 2017 - Unless noted differently in requirements.
Implementation date: October 2, 2017