This week in Medicare updates–6/28/2017
Two Massachusetts Healthcare Organizations Settle Fraud Cases
On June 16, the OIG announced that both UMass Medical Center and Boston Medical Center (BMC) settled false and fraudulent Medicare claims cases. In both cases, the settlement agreements resolved allegations that the organizations submitted claims for "new patient" evaluation and management outpatient clinic visits using HCPCS codes 99203-99205 when the patients at issue were actually "established patients." UMass Medical Center settled its case for $441,047.36; BMC for $313,246.
Reasonable Assurance Will Apply to Providers and Suppliers Who Voluntarily Terminate and Seek New Certification if a Termination Action by the State Agency has Been Initiated
On June 16, CMS issued a memorandum stating that reasonable assurance may be required for reapplying entities that if a termination action has been initiated but the entity is allowed to terminate Medicare participation voluntarily before the action is made effective, the reasonable assurance provision will be applied. If there is not a State Survey Agency (SA) certification of noncompliance at the time a provider/supplier notifies the organization of voluntary termination, the reasonable assurance provision does not apply.
New Guidance for the Formatting of the Plans of Correction
On June 16, CMS issued a memorandum stating that providers/suppliers and Clinical Laboratory Improvement Amendments (CLIA) Laboratories will no longer be required to write their Plans of Correction (POC) on the right side of the CMS Form 2567. Providers/suppliers or CLIA Laboratories may submit their PoC as a separate document attachment or may continue to document the PoC on the right side of the CMS Form 2567. However, it should be noted that The Laboratory Director or Provider/supplier representative’s signature is still required on the first page of the CMS Form 2567 for the PoC/AOC.
Effective date: Immediately
Clarification of Hepatitis C Screening Exception
On June 16, CMS released a memorandum stating that the Conditions for Coverage (CfC) for End Stage Renal Disease (ESRD) facilities include infection control requirements for the safety of each dialysis patient, their family and staff members. Recommendations for infection control, developed by the Centers for Disease Control and Prevention (CDC), are incorporated by reference into the ESRD CfCs and must be followed by all Medicare certified ESRD facilities. As such, surveyors should not cite ESRD facilities for a failure to conduct routine, or periodic screening for Hepatitis C.
Effective date: Immediately
Medicare Part A Skilled Nursing Facilities (SNF) Prospective Payment System (PPS) Pricer Update
On June 19, CMS published an MLN Matters Article to supplement Transmittal 3796, which was published on June 16. In the article, CMS advises SNFs paid under the PPS and Medicare Administrative Contractors (MAC) to be aware of changes in payment rates for 2018.
Effective date: October 1, 2017
Implementation date: October 2, 2017
Comment Request: Mandatory Insurer Reporting Requirements of Section 111 of the Medicare, Medicaid, and SCHIP Act of 2007; Add-On Payments for New Medical Services and Technologies Paid Under the Inpatient Prospective Payment System
On June 20, CMS published a Comment Request in the Federal Register regarding two information collections:
- Mandatory Insurer Reporting Requirements of Section 111 of the Medicare, Medicaid, and SCHIP Act of 2007
- Add-On Payments for New Medical Services and Technologies Paid Under the Inpatient Prospective Payment System
Comments are due by July 20, 2017.
Updates to the Quality Payment Program for 2018
On June 21, CMS published a Press Release regarding a new proposed rule that would make updates to the Quality Payment Program for 2018. This rule would provide proposed updates for the second and future years of the Quality Payment Program. CMS states that its goal is to simplify the program, especially for small, independent, and rural practices, while ensuring fiscal sustainability and high-quality care within Medicare. Comments are due August 21, 2017.
Changes to the Laboratory National Coverage Determination (NCD) Edit Software for October 2017
On June 21, CMS published an MLN Matters Article to supplement Transmittal 3797, which was published on June 16. In the article, CMS advises Medicare Administrative Contractors (MAC) and billing staffs to be aware of changes in the October 2017 quarterly release of the edit module for clinically diagnostic laboratory services.
Effective date: October 1, 2017
Implementation date: October 2, 2017
Comment Request: Clinical Laboratory Improvement Amendments (CLIA) Application Form and Supporting Regulations
On June 22, CMS published a Comment Request in the Federal Register for the CLIA Application Form and Supporting Regulations information request.
Comments are due August 21, 2017.
Implementing FISS Updates to Accommodate Section 603 Bipartisan Budget Act of 2015 - Phase 2
On June 23, CMS published Transmittal 1783 regarding the extract file of provider enrollment data that has been input via the Medicare Administrative Contractors, which will be generated out of the Provider Enrollment, Chain and Ownership System (PECOS) and available to load into the Fiscal Intermediary Standard System (FISS) claims system to populate the outpatient off-campus provider department's claims provider files so outpatient off-campus claims can be processed.
Effective date: January 1, 2017
Implementation date: July 3, 2017
Updates to the CMS-855R Processing Guide
On June 23, CMS published Transmittal 1860 to update the CMS-855R Processing Guide, which is used to assist providers/suppliers in completing, and the Medicare Administrative Contractors in processing, the CMS-855R application
Effective date: July 25, 2017
Implementation date: July 25, 2017
Medicare Claims Processing Manual Chapter 15 Update
On June 23, CMS published Transmittal 3800 to correct errors in the Medicare Claims Processing Manual, Publication 100-04, Chapter 15, section 20.1.4. The changes correct minor typographical errors.
Effective date: July 25, 2017
Implementation date: July 25, 2017