This week in Medicare updates–9/20/17
Hurricane Irma and Medicare Disaster Related Claims
On September 8, CMS published Special Edition MLN Matters 17022 for providers and suppliers who submit claims to Medicare for beneficiaries in Florida, the U.S. Virgin Islands, and the Commonwealth of Puerto Rico who were affected by Hurricane Irma. On September 11, CMS similarly published Special Edition MLN Matters 17024 for providers and suppliers who submit claims to Medicare for beneficiaries in South Carolina and Georgia who were affected by Hurricane Irma.
CMS has issued several blanket waivers in the impacted counties and geographical areas to prevent gaps in access to care for beneficiaries impacted by the emergency. Additional blanket waiver requests are being reviewed. Updated information can be found under Administrative Actions at www.cms.gov/About-CMS/Agency-Information/Emergency/Hurricanes.html.
2018 Annual Update of Healthcare Common Procedure Coding System (HCPCS) Codes for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Update
On September 8, CMS published MLN Matters 10262 regarding Medicare Claims Processing Transmittal 3857, which was published the same day. The transmittal makes changes to HCPCS codes and Medicare Physician Fee Schedule designations and will be used to revise CWF edits to allow A/B MACs to make appropriate payments in accordance with policy for SNF CB in Chapter 6, Section 110.4.1 for A/B MACs (B) and Chapter 6, Section 20.6 for A/B MACs (A)
Effective date: January 1, 2018
Implementation dates: January 2, 2018
Fiscal Year (FY) 2018 Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital (LTCH) PPS Changes
On September 11, CMS published MLN Matters 10273 regarding Medicare Claims Processing Transmittal 3858, which was published September 8. The transmittal contains information regarding the changes to IPPS and LTCH PPS for FY 2018.
Effective date: October 1, 2017
Implementation dates: October 2, 2017
Proper Use of the KX Modifier for Part B Immunosuppressive Drug Claims
On September 11, the OIG published a Report regarding Medicare Part B payment of immunosuppressive drugs billed with modifier -KX that were not eligible for payment. Of the 75 claims in the OIG’s random sample, pharmacies documentation supported the modifier for only 65 claims.
Adjustment of Civil Monetary Penalties for Inflation; Correcting Amendment for Interim Final Rule
On September 12, CMS published a Correcting Amendment for the Adjustment of Civil Monetary Penalties for Inflation Interim Final Rule published September 6, 2016, in the Federal Register. The correcting amendment revises a number of technical and typographical errors found in the new regulation, which adjusts the maximum civil monetary penalty amounts for inflation for all HHS agencies.
New Provider Self-Disclosure Settlements
On September 12, the OIG updated its list of Provider Self-Disclosure Settlements, including several settlements involving cases where providers employed individuals excluded from participation in federal healthcare programs, violating the Civil Monetary Penalties Law. Providers include:
- Nurse Practitioner Health Services, LLC (NPHS), of Ohio
- OSF Healthcare System, d/b/a OSF St. Francis Hospital & Medical Group (OSF), of Michigan
- Apex Dermatology and Skin Surgery Center, LLC (Apex), of Ohio
October Quarterly Update for 2017 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Fee Schedule
On September 12, CMS published MLN Matters 10248 regarding Medicare Claims Processing Transmittal 3859, which was published September 8. The transmittal contains information regarding the standard quarterly DMEPOS fee schedule quarterly update.
Effective date: October 1, 2017
Implementation dates: October 2, 2017
Correcting Payment of Inpatient Prospective Payment System (IPPS) Transfer Claims Assigned to Medicare Severity-Diagnosis Related Group (MS DRG) 385 and Allowing Part A Deductible on Medicare Secondary Payer (MSP) Same Day Transfer Inpatient Claims
On September 13, CMS published One-Time Notification Manual Transmittal 1918, which rescinds and replaces Transmittal 1870, dated July 27, 2017, to inform Medicare Administrative Contractors about a correction to Medicare's Fiscal Intermediary Shared System (FISS) assignment of review code for IPPS transfer claims assigned to MS-DRG 385, so that the IPPS Pricer will calculate the per diem transfer payment. Another correction allows Part A deductible, identified by a value code, on MSP same day transfer claims.
CMS also published the related MLN Matters 10145.
Effective date: January 1, 2018
Implementation date: January 2, 2018
Ongoing Efforts to Support Hurricane Irma Emergency Recovery
On September 13, CMS published a Press Release regarding ongoing emergency recovery efforts for those affected by Hurricane Irma. CMS is temporarily suspending certain Medicare enrollment screening requirements for providers assisting with recovery in Florida, Puerto Rico, and the U.S. Virgin Islands. CMS established a hotline to assist these providers in receiving temporary Medicare billing privileges.
New Medicare Card Design
On September 14, CMS published a Press Release regarding the release of its design for the new Medicare Cards. CMS will begin mailing new cards to beneficiaries in April 2018. All existing Medicare cards that contain patient Social Security numbers must be replaced by April 2019.
Comment Request: Medicare Geographic Classification Review Board Procedures and Criteria and Disclosure Requirement for the In-Office Ancillary Services Exception
On September 15, CMS published a Comment Request in the Federal Register regarding multiple information collections:
- Medicare Geographic Classification Review Board Procedures and Criteria
- Disclosure Requirement for the In-Office Ancillary Services Exception
Comments are due for October 16, 2017.
October 2017 Update of the Hospital Outpatient Prospective Payment System (OPPS)
On September 15, CMS published Medicare Claims Processing Manual Transmittal 3864, which rescinds and replaces Transmittal 3853, dated August 25, 2017, to update the policy section, correct an error to the OPPS status indicator for Q5102 in the attachment Table 5, and to include information on the revised OPPS status indicator and APC for CPT code 0421T in Section 6. In addition, Table 7 has been added.
Effective date: October 1, 2017
Implementation date: October 2, 2017
Updated Editing of Always Therapy Services - MCS
On September 15, CMS published Medicare Claims Processing Manual Transmittal 3863, which rescinds and replaces Transmittal 3814, dated July 27, 2017, to implement revised editing of Part B “Always Therapy” services to require the appropriate modifier for the service to be accurately applied to the therapy cap.
Effective date: January 1, 2018
Implementation date: January 2, 2018
Continued completion of Form CMS-339 by Rural Health Clinics and certain other provider types
On September 15, CMS published Provider Reimbursement Manual Transmittal 9 regarding Form CMS-339, which must be completed by all Community Mental Health Centers (CMHC), Rural Health Clinics (RHC), and Organ Procurement Organizations (OPO) submitting cost reports to the Medicare Administrative Contractors (MAC).
Effective date: Cost Reporting Periods Ending on or After September 30, 2017
Annual Clotting Factor Furnishing Fee Update 2018
On September 15, CMS published Medicare Claims Processing Manual Transmittal 3862 to announce the update to the Clotting Factor Furnishing Fee. For 2018, the clotting factor furnishing fee of $0.215 per unit is included in the published payment limit for clotting factors and shall be added to the payment for a clotting factor when no payment limit for the clotting factor is published either on the Average Sales Price (ASP) or Not Otherwise Classified (NOC) drug pricing files.
Effective date: January 1, 2018
Implementation date: January 2, 2018
New Corporate Integrity Agreements
On September 15, the OIG published two new Corporate Integrity Agreements:
- Med-Fast Pharmacy, Inc., Med-Fast Pharmacy, LP, Douglas Kaleugher, A Jane K, LLC, of Aliquippa, PA
- Family Medicine Centers of South Carolina, LLC, Stephen F. Serbin, MD, and Victoria Serbin, of Columbia, SC
September OIG Work Plan Additions
On September 15, the OIG updated its Work Plan to include several CMS items, including Medicare Part D Sponsors Reporting of Direct and Indirect Remunerations and several other Medicaid-related reviews.
Quarterly Update for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program (CBP) - January 2018
On September 15, CMS published Medicare Claims Processing Manual Transmittal 3861 regarding the DME CBP files, which are updated on a quarterly basis in order to implement necessary changes to the HCPCS, ZIP code, Single payment amount, and Supplier files. These transmittal communicates specific instruction for implementing the DMEPOS CBP files.
Effective date: January 1, 2018
Implementation date: January 2, 2018
Targeted Probe and Educate
On September 15, CMS published One-Time Notification Manual Transmittal 1919 regarding the expansion of existing Targeted Probe and Educate (TPE) Pilot to include all Medicare Administrative Contractors (MAC). The purpose of this expansion is to reduce appeals, decrease provider burden, and improve the medical review/education process.
Effective date: October 1, 2017
Implementation date: No later than October 1, 2017