This week in Medicare updates–8/30/2017
New Website Platform for Survey and Certification Information
On August 22, CMS issued a memorandum to State Survey Agency Directors regarding information related to the new QCOR website. The QCOR website launch replaces the previously known Survey and Certification Providing Data Quickly (S&C PDQ) system. The system imports data from a variety of data platforms, such as the Certification and Surveyor Provider Enhanced Reporting (CASPER) national database. However, S&C PDQ’s functionality and ease of access of information to providers and suppliers was limited, therefore CMS removed the requirements for username and passwords for accessing the data on the site, which has now become the new QCOR website.
OIG Advisory Opinion: A pharmaceutical manufacturer's proposal to replace products that require specialized handling that could not be administered to patients at no additional charge to the purchaser
On August 25, the OIG published an Advisory Opinion. A healthcare organization wrote the OIG requesting an advisory opinion regarding a pharmaceutical manufacturer’s proposal to replace products that require specialized handling that could not be administered to patients for certain reasons, at no additional charge to the purchaser, specifically regarding whether such a situation could constitute grounds for the imposition of sanctions under the Federal anti-kickback statute.
The OIG concluded that, although the proposed arrangement could potentially generate prohibited remuneration under the anti-kickback statute if the requisite intent to induce or reward referrals of Federal health care program business were present, the OIG would not impose administrative sanctions on this particular organization in connection with the proposed arrangement.
October 2017 Update of the Hospital Outpatient Prospective Payment System (OPPS)
On August 25, CMS published Medicare Claims Processing Transmittal 3853, updating billing, payment and coding policies for the OPPS for October 2017. The update included:
- Information on the new benefit for Peripheral Artery Disease (PAD) Rehabilitation
- New proprietary lab codes
- Four new pass-through drugs
- Instructions for correct reporting of certain flu vaccines
- Clarification on coding and payment of blepharoplasty performed with blepharoptosis
Table with new codes and other information are attached.
Effective date: October 1, 2017
Implementation date: October 2, 2017
October 2017 Integrated Outpatient Code Editor (I/OCE) Specifications Version 18.3
On August 25, CMS published Medicare Claims Processing Transmittal 3852. This notification provides the table with the Summary of Quarterly Release Modifications and the Summary of Data Changes, with all new, deleted and revised codes. These edits are used for claims processed under the Outpatient Prospective Payment System (OPPS) and Non-OPPS for hospital outpatient departments, community mental health centers, all non-OPPS providers, and for limited services when provided in a home health agency not under the Home Health Prospective Payment System or to a hospice patient for the treatment of a non-terminal illness. NOTE: the October quarterly update files have not been posted on the IOCE page at the time of publishing.
Effective date: October 1, 2017
Implementation date: October 2, 2017
October Quarterly HCPCS Update Adds New Modifier ZC
On August 25, CMS published Medicare Claims Processing Transmittal 3850, which informs the contractors about a new modifier, which will become effective for claims submitted beginning October 1, 2017 and applies retroactively to dates of service on or after July 24, 2017. The modifier (ZC: Merck/Samsung Bioepis) is used with Q5102 when a biosimilar manufactured by Merck/Samsung Bioepis is used.
Effective date: July 24, 2017
Implementation date: October 2, 2017
Updates Related to Covered Preventative Services
On August 25, CMS published Medicare Claims Processing Transmittal 3848, a change request which revises chapters 18 and 32 of the claims processing manual to update claims processing instructions and coverage information for smoking cessation, colorectal screening services and cardiac rehabilitation programs. These changes are intended only to clarify existing policy and no system or processing changes are anticipated.
Also on August 25, CMS published Medicare National Coverage Determinations Transmittal 202 revising the National Coverage Determinations manual related to this same change request.
Effective date: September 26, 2017
Implementation date: September 26, 2017
Inpatient Rehabilitation Facility (IRF) Annual Update: Prospective Payment System (PPS) Pricer Changes for FY 2018
On August 25, CMS published Medicare Claims Processing Transmittal 3849. A new IRF PRICER software package will be released prior to October 1, 2017, that will contain the updated rates that are effective for claims with discharges that fall within October 1, 2017, through September 30, 2018.
Effective date: October 1, 2017
Implementation date: October 2, 2017
File Conversions Related to the Spanish Translation of the Healthcare Common Procedure Coding System (HCPCS) Descriptions
On August 25, CMS published Medicare Claims Processing Transmittal 3851.This change request provides direction for the contractors to perform any necessary file conversions related to the Spanish translation of the HCPCS descriptions provided by First Coast Service Options (FCSO) on a quarterly basis.
Effective date: October 1, 2017
Implementation date: October 2, 2017