This week in Medicare updates–7/5/2017
Final Notice: CMS approves Centers for Improvement in Healthcare Quality (CIHQ) for continued recognition as accrediting organization
On June 26, CMS gave final notice in the Federal Register that a decision has been made to continue approving the CIHQ as a national accrediting organization for hospitals that wish to participate in Medicare and Medicaid programs. This decision was made after an administrative review or CIHQ, a comparison of CIHQ’s Medicare accreditation standards to CMS’ current Medicare hospital Conditions of Participation, and a documentation review of CIHQ’s survey process.
Effective date: July 26, 2017, through July 26, 2023
Changes to the National Plan and Provider Enumeration System (NPPES)
On June 27, CMS issued an MLN Matters discussing recent changes to the NPPES, which is used to obtain or update a National Provider Identifier (NPI) account. CMS has modernized the NPPES (NPPES 3.0) that now has unified login for type 1 and type 2 providers which increases security, provides new surrogacy functionality, has a more responsive User Interface (UI) and a streamlined NPI application process, among other new features.
Extension of the Transition to the Fully Adjusted Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Payment Rates
On June 27, CMS issued Transmittal 3801, which rescinds and replaces Transmittal 3716. This provides instructions regarding the implementation of revised 2016 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) fee schedule amounts based on changes mandated by the 21st Century Cures Act. These changes relate to the new Chapter 20, Section 20.6 (Phase-In for Competitive Bidding Rates in Areas Not in a Competitive Bid Area) of the Medicare Claims Processing Manual. CMS also issued an MLN Matters 9968 about this change June 28.
Effective date: July 1, 2016
Implementation date: October 2, 2017
Implementing Fiscal Intermediary Standard System (FISS) Updates to Accommodate Section 603 Bipartisan Budget Act of 2015 - Phase 2
On June 27, CMS published MLN Matters 9907, associated with 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 FISS claims system to populate the outpatient off-campus provider department's claims provider files so outpatient off-campus claims can be processed. MLN Matters suggests that if a hospital claim is submitted with a service facility location that was not included on the CMS 855A enrollment form, the claim will be Returned to the Provider (RTP) until the CMS 855A enrollment form and claims processing system are updated.
Effective date: January 1, 2017
Implementation date: July 3, 2017
Qualified Medicare Beneficiary Status Indicator
On June 28, CMS issued Transmittal 3802, which rescinds and replaces Transmittal 3715, dated April 28, 2017, to create an indicator of Qualified Medicare Beneficiary (QMB) status in the claims processing systems (shared systems - CWF, FISS, MCS, and VMS). Beneficiaries enrolled in the QMB program are not liable to pay Medicare cost sharing for all Medicare A/B claims. The new claims processing systems QMB indicator will trigger notifications to providers (through the Provider Remittance Advice) and to beneficiaries (through their Medicare Summary Notice) to reflect that the beneficiary is a QMB individual and lacks Medicare cost sharing liability. CMS also revised MLN Matters 9911 June 29 to reflect this transmittal.
Effective date: October 2, 2017, for claims processed on or after this date
Implementation date: July 3, 2017
Hospital Discharge Appeal Notices
On June 29, CMS updated its webpage on Hospital Discharge Appeal Notices with a reminder that the effective date for use of the updated Important Message from Medicare (IM) and Detailed Notice of Discharge (DND) is 60 days from June 29. Hospitals are required to deliver the IM, CMS-R-193 to all Medicare beneficiaries (Original Medicare beneficiaries and Medicare Advantage plan enrollees) who are hospital inpatients. The IM informs hospitalized inpatient beneficiaries of their hospital discharge appeal rights. Beneficiaries who choose to appeal a discharge decision must receive the DND from the hospital or their Medicare Advantage plan, if applicable.
Effective date: 60 days from June 29
End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) 2018 Proposed Rule
On June 29, CMS issued a proposed rule that would make revisions to the ESRD PPS for calendar year (CY) 2018, as well as to update the payment rate for renal dialysis services furnished by an ESRD facility to individuals with acute kidney injury (AKI). This rule also proposes to set forth requirements for the ESRD Quality Incentive Program (QIP), including for payment years (PY) 2019 through 2021. Comments are due by August 28, 2017.
CMS also issued a Press Release and a Fact Sheet about this proposed rule.
Hepatitis B Screening: New Effective Dates
On June 29, CMS issued Transmittal 198 and Transmittal 3804, which correct the verbiage in earlier transmittals to split release dates for new Hepatitis B Virus (HBV) infection screening programs. As in earlier versions of this transmittal, CMS has determined that screening for HBV infection will be covered with the appropriate U.S. Food and Drug Administration (FDA) approved/cleared laboratory tests, used consistent with FDA-approved labeling and in compliance with the Clinical Laboratory Improvement Act (CLIA) regulations.
Effective date: September 28, 2016
Implementation dates:
Analysis and Design: October 2, 2017
Testing and Implementation: January 2, 2018
Targeted Probe and Educate (TPE) Pilot
On June 29, CMS published Transmittal 1861, which changes the reporting date for the TPE Pilot from the 10th of the month to the 20th and replaces the flowchart with an updated flowchart. The purpose of the expansion of TPE is to test the strategy for Durable Medical Equipment as well as urban regions.
Effective date: July 3, 2017
Implementation date: July 3, 2017
New Introductory Letters for Suppliers and Providers of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items
On June 30, CMS published Transmittal 1862, which serves as an alert to the Medicare Administrative Contractors that stakeholder education, in the form of the attached Introductory Letters, shall be sent to the DMEPOS suppliers and pertinent physicians/practitioners.
Effective date: July 31, 2017
Implementation date: July 31, 2017