This week in Medicare updates—10/14/2020
October 2020 Integrated Outpatient Code Editor (I/OCE) Specifications Version 21.3.R1
On October 2, CMS published Medicare Claims Processing Transmittal 10382, which rescinds and replaces Transmittal 10332, dated August 28, 2020 to update the attachments. The original transmittal was issued regarding the regular quarterly update to the I/OCE. The replacement transmittal was issued regarding additions to the IOCE and re-release of the accompanying data files.
Effective date: October 1, 2020
Implementation date: October 5, 2020
Provider Compliance Tips for Continuous Positive Airway Pressure (CPAP) Devices and Accessories
On October 5, CMS updated an MLN Fact Sheet regarding coverage and proper billing of CPAP devices and accessories. The updates include changing data to information from the 2019 reporting period, when the fee-for-service improper payment rate for CPAP was 32.7%. CMS projected that there were improper payments of just over $250 million for the 2019 reporting period.
Nursing Shortage as an “Extraordinary Circumstance” per 42 CFR 418.64 Core Services
On October 5, CMS published a Memorandum to state survey agency directors regarding hospice staffing requirements and nursing shortages. The memo updates previous guidance about notifying CMS and submitting justification for use of contracted staff during extraordinary circumstances. The regulation now does not require hospices to receive a waiver or exemption from the state survey agency or the CMS location when using contracted staff temporarily to supplement hospice employees under extraordinary or other non-routine circumstances. Hospices cannot, however, use contracted nursing services in lieu of direct nursing services, as that is a violation of 42 CFR 418.64.
Effective date: Immediately. This policy should be communicated with all survey and certification staff, their managers, and the state/regional office training coordinators within 30 days of the memo.
Compliance with Residents’ Rights Requirement Related to Nursing Home Residents’ Right to Vote
On October 5, CMS published a Memorandum regarding clarification on the right of nursing home residents to vote in elections. Despite limitations on visitors during the public health emergency, nursing homes must still ensure that residents are able to vote should they wish to do so, and CMS encourages states, localities, and nursing home owners/administrators to work together to find a safe way for residents to vote during the pandemic. CMS also advises against the use of nursing homes as polling locations for the general public during the COVID-19 pandemic.
CMS also published a Letter to send to residents and family members about the right to vote.
Effective date: Immediately. This policy should be communicated with all survey and certification staff, their managers, and the state/regional office training coordinators immediately.
Interim Final Rule, CMS-3401 IFC: Requirements and Enforcement Process for Reporting of COVID-19 Data Elements for Hospitals and Critical Access Hospitals (CAH)
On October 6, CMS published a Memorandum to CMS locations, state agencies, hospitals, CAHs, and other stakeholders regarding new COVID-19 data reporting requirements for CAHs and hospitals per a September 2, 2020 IFC. The memo includes a table of what information needs to be reported daily, what information needs to be reported weekly, and what should be reported for certain influenza fields. The memo also details the enforcement process for noncompliance. Hospitals or CAHs that do not comply with these requirements may have their Medicare provider agreement terminated.
CMS published a Workflow Infographic showing the mandatory COVID-19 reporting enforcement timeline to accompany the memo.
Effective date: Immediately. This policy should be communicated with all survey and certification staff, their managers, and the CMS Location training coordinators of this memorandum.
Medicare Critical Care Services Provider Compliance Audit: Clinical Practices of the University of Pennsylvania
On October 6, the OIG published a Review of whether Clinical Practices of the University of Pennsylvania complied with Medicare requirements for billing for critical care services performed by its physicians. The OIG found that Clinical Practices complied with billing requirements for 136 of the 150 critical care services claims reviewed. However, 14 claims reviewed did not meet Medicare requirements for medical necessity of critical care and should have been billed using a CPT code for subsequent hospital care instead. These errors resulted in estimated overpayments of at least $151,588 during the audit period. The OIG recommends Clinical practices refund the MAC for the overpayments, find and return any similar overpayments, and strengthen policies and procedures to ensure that critical care services billed to Medicare are adequately documented and correctly billed.
CMS Announces New Repayment Terms for Medicare Loans Made to Providers During COVID-19
On October 8, CMS published a Press Release announcing amended terms for repayments of loans issued under the Accelerated and Advance Payment (AAP) Program. On October 1, Congress enacted the Continuing Appropriations Act, 2021 and Other Extensions Act, which extended repayment of any payments issued via the AAP Program to one year from the date the payment was issued. At that point, repayment will begin via automatic recoupment of 25% of Medicare payments otherwise owed to the provider or supplier. After the first 11 months of recoupment, Medicare payments owed will be recouped at a rate of 50% for six months. After those six months end, providers and suppliers will receive a letter requesting full repayment of any remaining balance. If payment is not received within 30 days, interest will accrue at a 4% rate from the date the letter is issued and will be assessed for each 30-day period during which the balance remains unpaid.
Quality Reporting Programs: COVID-19 Public Reporting
On October 8, CMS updated public reporting tip sheets for Skilled Nursing Facilities and Long-Term Care Hospitals regarding reporting for CMS quality data submissions that were either optional or excepted from public reporting due to the COVID-19 PHE.
High-Quality Care for Medicare Beneficiaries Continues as Medicare Health and Drug Plans Receive Star Ratings
On October 8, CMS published a Press Release regarding the star ratings for 2021 Medicare Advantage and Part D Prescription Drug Plans. In 2021, approximately 49% of Medicare Advantage plans offering prescription drug coverage in 2021 will have at least a four-star rating, down slightly from 52% of plans earning this rating for 2020. The average star rating for all Medicare Advantage plans with prescription drug coverage decreased down to 4.06 for 2021, matching the level from 2019. In 2020, the average star rating for these plans was 4.16.
On October 8, CMS published a Fact Sheet with more specific data on the 2020 star ratings.