This week in Medicare updates–7/26/2017
Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure to Procedure (PTP) Edits
On July 17, CMS published MLN Matters 10183, supplementing Transmittal 3807, which announced the quarterly update to the NCCI PTP Edits. This MLN Matters further details the importance of correct coding methodologies and refers readers to helpful information.
Effective date: October 1, 2017
Implementation date: October 2, 2017
Medicare Claims Processing Manual Chapter 15 Update
On July 17, CMS published MLN Matters 10143, to supplement Transmittal 3800, which was published in June. This MLN Matters further explains the typographical errors in Medicare Claims Processing Manual, Publication 100-04, Chapter 15, section 20.1.4 that were corrected by its accompanying transmittal.
Effective date: July 25, 2017
Implementation date: July 25, 2017
Assistant Inspector General for Evaluation and Inspections Office of Inspector General Testifies Before Congress
On July 18, Erin Bliss, assistant inspector general for the evaluation and inspections office at the OIG testified before the House Committee on Energy and Commerce: Subcommittee on Oversight and Investigations: "Examining HRSA's Oversight of the 340B Drug Pricing Program.”
Bliss testified that the OIG reviews have explored various aspects of the 340B program, identified potential vulnerabilities, and offered several recommendations to promote program integrity. Some of the weaknesses identified have been addressed through legislation, or by HRSA directly. She did explain that some long-standing, fundamental vulnerabilities do persist, impeding effective program oversight and operations.
Ms. Bliss specifically flagged concerns regarding a lack of transparency in order to ensure accurate payments and uncertainty regarding program rules that have resulted in uneven implementation across the program.
Proposed Rulemaking: Revisions to the Outpatient Prospective Payment System (OPPS) for Calendar Year (CY) 2018
On July 20, CMS announced a proposed rule in the Federal Register. These changes would revise the Medicare hospital OPPS and the Medicare ambulatory surgical center (ASC) payment system for CY 2018. .
Some of these proposed revisions would include:
- Updates to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS, as well as those paid under the ASC payment system
- Updates to the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program
- Changes to the list of Inpatient Only procedures
- Changes to 340B Drug Pricing
- Changes to payment for services performed in off-campus provider-based departments who report modifier -PN
Comments are due by September 11.
Additional Information on the 2018 Medicare Physician Fee Schedule (MPFS) and Other Revisions to Part B for Calendar Year (CY )2018; Medicare Shared Savings Program Requirements; and Medicare Diabetes Prevention Program
On July 21, CMS published in the Federal Register additional information pertaining to 2018 MPFS and Other Revisions to Part B for CY 2018, including a list of specialties excluded from rate setting calculations, applications of payment modifiers to utilization fees, maximum interest rates, proposed crosswalks of specialties to similar specialties, and more.
Comments on this information are due by September 11.
Final Allotments for Medicare Part B premiums for Fiscal Year (FY) 2014
On July 21 CMS announced in the Federal Register that the states' final allotments are now available to pay the Medicare Part B premiums for Qualifying Individuals (QIs) for FY 2014, as well as the preliminary allotments for federal FY 2015, which is extended through calendar year (CY) 2015 by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
Revision of the Quality Improvement Organization (QIO) Manual
On July 21, CMS published Transmittal 31, which revises several sections of the QIO Manual. Among the changes are clarification regarding the authority for CMS to enter into contracts with QIOs to evaluate QIO performance; methods of evaluation; terms for renewal and non-renewal; performance improvement plans; and more.
Effective date: July 21, 2017
Implementation date: July 21, 2017
Revision of the Provider Reimbursement Manual, Part 1
On July 21, CMS published Transmittal 474. This transmittal updates Chapter 9, Compensation of Owners, providing guidelines for physician owner compensation for rural health clinics, as well as the labor related factor for professional fees reported on the PPS hospital input price index.
Effective date: The inflation factors in section 905.6 are applied on a calendar year basis. The guidelines in section 905.7 are provided beginning with cost reporting periods beginning in Federal Year (FY) 2009.
Clarifying the Instructions for Amending or Correcting Entries in Medical Records
On July 21, CMS published Transmittal 732, which reclarifies the requirements for a practitioner to authenticate an alteration or revision in the medical records. Specifically, it states that the contractor shall accept initials in instances when the author of the alteration must sign and date a revision made.
Effective date: August 22, 2017
Implementation date: August 22, 2017
October 2017 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
On July 21, CMS published Transmittal 3809, which sets the quarterly average sales price (ASP) for Medicare Part B Drug Pricing Files for October.
Effective date: October 1, 2017
Implementation date: October 2, 2017