This week in Medicare updates–6/7/2017
National Coverage Analysis (NCA) for Implantable Cardioverter Defibrillators (CAG-00157R4)
On May 30, CMS posted a new Tracking Sheet regarding the reconsideration of Section 20.4 of the NCD Manual, which establishes conditions of coverage for implantable cardioverter defibrillators. The initial 30-day public comment period begins with this posting date, and ends after 30 calendar days.
Social Security Removal Initiative (SSNRI) Outreach Campaign
On May 30, CMS published a Press Release regarding the a new outreach campaign regarding its Social Security Removal Initiative (SSNRI). New cards will use a unique, randomly-assigned number Medicare Beneficiary Identifier to replace the Social Security-based Health Insurance Claim Number used currently. CMS will begin mailing new cards in April 2018 and will replace all cards by April 2019.
Scheduled End of the Intravenous Immune Globulin (IVIG) Demonstration
On May 30, CMS published Special Edition MLN Matters 17008 regarding the end of the three-year IVIG demonstration on September 30, 2017. No payment will be made for the demonstration services (Q2052- IVIG demonstration, services/supplies) rendered after that date. Medicare fee-for-service will continue to pay for IVIG in the home but will no longer pay for the services and supplies to administer the drug after the demonstration ends unless the beneficiary is receiving covered Medicare home health services.
July 2017 Update of the Hospital Outpatient Prospective Payment System (OPPS)
On May 30, CMS published MLN Matters 10122 to accompany the associated Transmittal 3783, published May 26, 2017. The transmittal is regarding changes to and billing instructions for various payment policies implemented in the July 2017 OPPS update.
Effective date: July 1, 2017
Implementation date: July 3, 2017
Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print Update
On May 30, CMS published MLN Matters 10040 to accompany the associated Transmittal 3780, published May 26, 2017. The transmittal updates the RARC and CARC lists and also to instruct ViPS Medicare System (VMS) and Fiscal Intermediary Shared System (FISS) to update MREP and PC Print.
Effective date: October 1, 2017
Implementation date: October 2, 2017
Claim Status Category and Claim Status Codes Update
On May 30, CMS published MLN Matters 10043 to accompany the associated Transmittal 3782, published May 26, 2017. The transmittal updates the Claim Status and Claim Status Category Codes used for the Accredited Standards Committee (ASC) X12 276/277 Health Care Claim Status Request and Response and ASC X12 277 Health Care Claim Acknowledgment transactions.
Effective date: October 1, 2017
Implementation date: October 2, 2017
Implement Operating Rules - Phase III Electronic Remittance Advice (ERA) Electronic Funds Transfer (EFT): CORE 360 Uniform Use of Claim Adjustment Reason Codes (CARC), Remittance Advice Remark Codes (RARC), and Claim Adjustment Group Code (CAGC) Rule
On May 30, CMS published MLN Matters 10041 to accompany the associated Transmittal 3781, published May 26, 2107. The transmittal instructs contractors and Shared System Maintainers (SSM) to update systems based on the CORE 360 Uniform Use of CARC, RARC, and CAGC Rule publication.
Effective date: October 1, 2017
Implementation date: October 2, 2017
New Corporate Integrity Agreements
On May 31, the OIG published information on two new corporate integrity agreements with the following providers:
- eClinicalWorks, LLC, of Westborough, MA
- Freedom Health Inc. and Optimum Healthcare, Inc., of Tampa, FL
Recovery Audit Region 4 updates
The Recovery Auditor for Region for, HMS, now has a live Provider Portal with updates and information for providers. In addition, HMS has now received CMS approval to begin audits for the Noridian JE and JF Medicare Administrative Contractor (MAC) Part A and Part B Jurisdiction.
Spring 2017 Semiannual Report to Congress
On June 1, the OIG published its Spring 2017 Semiannual Report to Congress, covering OIG activity from October 2016 through March 2017. During the reporting period, efforts resulted in the filing of charges against 49 individuals or entities, 152 criminal actions, and more than $266.8 million in investigative receivables.
New Provider Self-Disclosure Settlements and Corporate Integrity Agreements
On June 2, the OIG posted information on a new corporate integrity agreements with Andover Subacute and Rehab Center Services Two, Inc., of Lyndhurst, NJ. In addition, the OIG published information on several new Provider Self-Disclosure Settlements, including:
- UnityPoint at Home of Iowa agreed to pay $18,562.95 for allegedly employing an individual that it knew or should have known was excluded from participation in federal healthcare programs.
- BrightView, LLC, of Ohio agreed to pay $19,935.59 for allegedly employing an individual that it knew or should have known was excluded from participation in federal healthcare programs.
- Abingdon Convalescent Ambulance Service, Inc., of Pennsylvania agreed to pay $20,087.98 for allegedly submitting claims to federal healthcare programs for ambulance transportation services provided an employee with EMT-Intermediate certification when the employee had the EMT-Basic certification.
Comment Request: Home Health Agency Survey and Deficiencies Report and QIC Demonstration Evaluation Contractor: Analyze Medicare Appeals to Conduct Formal Discussions and Reopenings with Suppliers
On June 2, CMS posted a Comment Request in the Federal Register regarding the following information collections:
- Home Health Agency Survey and Deficiencies Report
- QIC Demonstration Evaluation Contractor (QDEC): Analyze Medicare Appeals to Conduct Formal Discussions and Reopenings with Suppliers
Targeted Probe and Educate (TPE) Pilot
On June 2, CMS published Transmittal 1855 regarding an expansion of the existing TPE Pilot to include three additional contractors, Jurisdictions B, D, E, and F. The purpose of this expansion is to test the TPE strategy for Durable Medical Equipment as well as urban regions.
Effective date: July 3, 2017
Implementation date: July 3, 2017
Update to General Information, Eligibility, and Entitlement, Chapter 7 - Contract Administrative Requirements, Section 40 – Shared System Maintainer Responsibilities for Systems Releases
On June 2, CMS published Transmittal 105 to update the Internet-Only Manual, Chapter 7, Section 40 and its subsections, to provide greater detailed descriptions in the Standard Terminology Chart, add the Single Testing Contractor non-testable conditions chart, and add the entities responsible for testing to the definitions section.
Effective date: July 3, 2017
Implementation date: July 3, 2017
July 2017 Update of the Ambulatory Surgical Center (ASC) Payment System
On June 2, CMS published Transmittal 3788 to describe changes to and billing instructions for various payment policies implemented in the July 2017 ASC payment system update. This transmittal also includes the associated HCPCS code updates.
Effective date: July 1, 2017
Implementation date: July 3, 2017