This week in Medicare updates–8/09/2017
Updated Editing of Always Therapy Services
On August 1, CMS published MLN Matters Number MM10176, which supplements Medicare Claims Transmittal 3814, updated editing of ‘Always Therapy’ services, issued on July 27.
Effective date: January 1, 2018
Implementation date: January 2, 2018
New CIA Reportable Event Settlement
On August 1, the OIG published information on a new CIA Reportable Event Settlement, which involved Luitpold Pharmaceuticals, Inc. (LPI) and American Regent, Inc. (ARI), which entered into a $1,237,100 settlement agreement with OIG.
July Quarterly Update for 2017 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule
On August 2, CMS published Medicare Claims Processing Manual Transmittal 3824 to rescind and replace Transmittal 3760 from April 28, 2017. This updates the policy section on complex rehabilitative power wheelchair accessories, including seat and back cushions. All other information remains the same.
CMS also published a revised version of MLN Matters 10071 on August 2 to reflect these changes.
Effective date: July 1, 2017
Implementation dates: July 3, 2017
CMS Announces National Coverage Decision (NCD) Regarding Leadless Pacemakers
On August 2, CMS published MLN Matters Number MM10117, which supplements Medicare Claims Processing Transmittal 3815, published on July 28, announcing the coverage conditions for leadless pacemakers under Coverage with Evidence Development.
Effective Date: January 18, 2017
Implementation Date: August 29, 2017 - for Medicare Administrative Contractor ( MAC) local edits; January 2, 2018 - for shared edits
Medicare Issues Projected Drug Premiums for 2018
On August 2, CMS issued a Press Release stating it projects that the average basic premium for a Medicare Part D prescription drug plan in 2018 will decline to an estimated $33.50 per month. This represents a decrease of approximately $1.20 below the actual average premium of $34.70 in 2017.
CMS Announces Revisions to Inpatient Prospective Payment System (IPPS)
On August 2, CMS published a Notice regarding pending revisions to the the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals. Included in these revisions are changes relating to the provider-based status of Indian Health Service (IHS) and Tribal facilities and organizations and to the low-volume hospital payment adjustment for hospitals operated by the IHS or a Tribe.
CMS also released two Press Releases, which includes a second release on August 2, and a Fact Sheet on this topic.
Effective date: October 1, 2017
Financial Year (FY) 2018 Inpatient Psychiatric Facilities Prospective Payment System Update
On August 2, CMS published a Notice that would update the prospective payment rates for Medicare inpatient hospital services provided by inpatient psychiatric facilities (IPFs), including freestanding IPFs and psychiatric units of an acute care hospital or critical access hospital.
These changes are applicable to IPF discharges beginning October 1, 2017 through September 30, 2018.
On August 4, CMS published a related transmittal, Medicare Claims Processing Transmittal 3826 , which identifies changes that are required as part of the annual IPF PPS update from the FY 2018 IPF PPS Notice. These changes are applicable to IPF discharges occurring during fiscal year October 1, 2017 through September 30, 2018.
CMS also released a Fact Sheet on this topic.
Comments will be due no later than 30 days after this notice appears in the Federal Register.
Effective Date: October 1, 2017
Implementation Date: October 2, 2018
Cotiviti Reviewing Use of Condition Code 42
On August 3, Recovery Audit Contractor Cotiviti announced that it launched a complex review regarding the use of Inpatient Hospital Validation of Condition Code 42 in both regions 2 and 3; Cotiviti cites incorrect use of billing condition code 42 on claims with discharge status code 06 by Inpatient Prospective Payment System hospitals as the cause of this review.
CMS Quarterly Notice Published
On August 4, CMS published its Quarterly Notice of CMS manual instructions, substantive and interpretive regulations in the Federal Register. This notice serves as an index of all Federal Register notices that were published from April through June 2017, relating to the Medicare and Medicaid programs and other programs administered by CMS.
This notice is organized into 15 addenda so that a reader may access the subjects published during the quarter covered by the notice to determine whether any are of particular interest.
2018 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements
On August 4, CMS published a Notice in the Federal Register about updates to the hospice wage index, payment rates, and cap amount for fiscal year (FY) 2018. The updates also include new quality measures and provide an update on the hospice quality reporting program.
CMS also released a Press Release and a Fact Sheet addressing this topic.
Effective date: October 1, 2017
Extension of Comment Request: Medicare Approved Outpatient Physical Therapy/Outpatient Speech Pathology (OPT/OSP) Providers and Supporting Regulations
On August 4, CMS published a Notice in the Federal Register that it will be extending the comment request and information collection period regarding the identification of extension units of Medicare approved outpatient physical therapy and outpatient speech pathology (OPT/OSP).
Comments are due by October 3, 2017.
Prospective Payment System (PPS) and Consolidated Billing for Skilled Nursing Facilities (SNF) for 2018
On August 4, CMS published a Notice in the Federal Register that updates the payment rates used under the PPS for SNFs for FY 2018. It also revises and rebases the market basket index by updating the base year from 2010 to 2014, and by adding a new cost category for Installation, Maintenance, and Repair Services. The rule also finalizes revisions to the SNF Quality Reporting Program (QRP), including measure and standardized resident assessment data policies and policies related to public display.
It also finalizes policies for the Skilled Nursing Facility Value-Based Purchasing Program that will affect Medicare payment to SNFs beginning in FY 2019.The final rule also finalizes the performance period for the National Healthcare Safety Network (NHSN) Healthcare Personnel (HCP) Influenza Vaccination Reporting Measure included in the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP) for Payment Year 2020.
CMS also released both a Press Release and a Fact Sheet addressing this topic.
Effective Date: October 1, 2017
New Corporate Integrity Agreements
On August 4, the OIG published information on several new Corporate Integrity Agreements, including:
- VNA of Greater Tift, Inc., of Tifton, GA.
- Norman, M.D., James and Norman Parathyroid Center, P.A., of Wesley Chapel, FL.
- Medi-Lynx Cardiac Monitoring, LLC., of Plano, TX.
The OIG also closed the following cases:
- Valley Heart Consultants, P.A.; Mego, Carlos D.; Yarra, Subbarao, M.D., of McAllen, TX.
- Pinnacle Medical Solutions, LLC, of Southaven, MS.
- Apex Medical Group, P.C.; Siddiqi, Naseemul, M.D., of Knoxville, TN
Medicare Paid New England Providers Twice for Nonphysician Outpatient Services Provided Shortly Before or During Inpatient Stays During Calendar Years 2013 and CY 2014
On August 4, the OIG announced that New England providers were not always correct for nonphysician outpatient services provided within 3 days prior to the date of admission, on the date of admission, or during Inpatient Prospective Payment System (IPPS) stays. For 75 of the 129 services the OIG sampled, Medicare paid providers twice, resulting in total overpayments of $288,000.
The OIG recommends that National Government Services recovers the portion $288,000 in identified overpayments, notify of potential additional overpayments, and educate all providers of their responsibilities under Medicare requirements to bill accurately for inpatient and outpatient services to prevent improper payments.
Revisions to the Home Health Pricer to Support Value-Based Purchasing and Payment Standardization
On August 4, CMS published Medicare Claims Processing Manual Transmittal 3829 to revise the record layout for the home health Pricer interface to support new payment and data initiatives, and add consistency editing to ensure the accurate reporting of site of service G-codes on home health visit line items.
Effective date: January 1, 2018
Implementation dates: January 2, 2018
Screening for Hepatitis B Virus (HBV) Infection
On August 4, CMS published Medicare Claims Processing Transmittal 3831 which rescinds and replaces Transmittal 3831 from June 29. This transmittal updates the manual so that payment for HBV is not separately payable for ESRD facilities (72X TOB) unless reported with Modifier AY. All other information remains the same.
Effective date: September 28, 2016
Implementation dates: October 2, 2017 - Analysis and Design
January 2, 2018- Testing and implementation
Provider-Based (PB) Determination
On August 4, CMS published CMS Manual System Transmittal 1891 which is to advise the Medicare Administrative Contractors (MACs) to use the electronic PB checklist to perform uniform reviews of PB applications.
Effective date: November 6, 2017
Implementation dates: November 6, 2017
Implementation of the Transitional Drug Add-On Payment Adjustment
On August 4, CMS published CMS Manual System Transmittal 1889 which implements the Transitional Drug Add-on Payment Adjustment. It is a designation process for determining when a drug is no longer an oral-only drug; and including new injectable and intravenous products into the End Stage Renal Disease Prospective Payment System (ESRD PPS). Under the drug designation process, CMS provides payment using a Transitional Drug Add-on Payment Adjustment (TDAPA) for new injectable or intravenous drugs and biologicals that qualify.
Effective date: January 1, 2018
Implementation dates: January 2, 2018
October Quarterly Update to 2017 Annual Update of Healthcare Common Procedure Coding System (HCPCS) Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement
On August 4, CMS published Medicare Claims Processing Transmittal 3825. This notification provides updates to the lists of HCPCS codes that are subject to the consolidated billing provision of the SNF Prospective Payment System (PPS).
Changes to CPT/HCPCS codes and Medicare Physician Fee Schedule designations will be used to revise CWF edits to allow MACs to make appropriate payments in accordance with policy for SNF consolidated billing.
Effective date: October 1, 2017
Implementation dates: October 2, 2017
Quarterly Influenza Virus Vaccine Code Update - January 2018
On August 4, CMS published Medicare Claims Processing Transmittal 3827. Every quarter, the influenza virus vaccine code is updated. Beginning January 2, 2018, code 90756 should be used for the influenza vaccine.
Effective date: August 1, 2017
Implementation dates: January 2, 2018