This week in Medicare updates—10/16/2019
Adjustment to the Amount in Controversy Threshold Amounts for Calendar Year 2020
On October 7, CMS published a Notice in the Federal Register to announce the annual adjustment in the amount in controversy (AIC) threshold amounts for Administrative Law Judge (ALJ) hearings and judicial review. The 2020 AIC threshold is $170 for ALJ hearings and $1,670 for judicial review.
Effective date: The annual adjustment takes effect on January 1, 2020
MLN Matters Articles on Medicare-Covered Preventive Services
On October 7, CMS published an updated listing of MLN Matters Articles on topics relevant to preventive services. The updates include links to 2019 articles on flu resources, flu vaccine payments, and pre-diabetes services.
FY 2020 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) PPS Changes
On October 7, CMS published Medicare Claims Processing Transmittal 4390 regarding updates to the rates and payment factors for the IPPS and LTCH PPS and the implementation of policies finalized in the 2020 IPPS final rule.
CMS published MLN Matters 11361 on the same date to accompany the transmittal.
Effective date: October 1, 2019
Implementation date: October 7, 2019
Updates to the Nursing Home Compare Website and Five Star Quality Rating System
On October 7, CMS published a Memorandum to state survey agency directors regarding updates to the Nursing Home Compare website and the Five Star Quality Rating System. CMS will be removing two quality measures from both Nursing Home Compare and the Five Star Quality Rating regarding the percentage of residents reporting moderate to severe pain as a way to avoid a scenario in which a facility may decide to administer opioids in an attempt to improve performance on quality measures related to pain. CMS is also updating the thresholds for quality measure ratings in April 2020 and identified three upcoming dates for updates to the rating system and website (October 23, December 4, and January 29).
CMS published a Press Release regarding the updates on the same date.
Effective date: October 23, 2019
Consumer Alerts Added to the Nursing Home Compare Website and the Five Star Quality Rating System
On October 7, CMS published a Memorandum to state survey agency directors regarding updates to abuse indicators and consumer alerts. CMS will add an abuse icon to make it easier for consumers to identify facilities with instances of non-compliance related to abuse. It will also add a disclaimer on Nursing Home Compare to alert consumers that some abuse investigations in Oregon may not have been investigated by state health inspectors and therefore potential findings of abuse may not be reflected on the website. This is due to an inconsistency in which the Oregon state survey agency was referring cases of potential abuse to the Department of Adult Protective Services rather than investigating under the CMS authority delegated to them.
Effective date: October 23, 2019
Correction: IPPS Final Rule
On October 8, CMS published a Correction in the Federal Register to the FY 2020 IPPS final rule. Some of the corrections include fixing an error in the historical claims data in the FY 2018 MedPAR files used in rate setting for the final rule’s MS-DRG relative weights, budget neutrality factors, and the final outlier threshold; correcting an error in the calculation of Factor 3 of the uncompensated care payment methodology; solving an error in the Medicare Geographic Classification Review Board reclassification status for one hospital and the application of the rural floor to one hospital; fixing an error related to the application of the out-migration adjustment, and more.
Effective date: This correcting document is effective on October 7, 2019
Applicability date: The corrections in this correcting document are applicable to discharges occurring on or after October 1, 2019.
Proposed Rule: Modernizing and Clarifying the Physician Self-Referral Regulations
On October 9, CMS published the draft version of a Proposed Rule regarding long-anticipated revisions to physician self-referral regulations under Stark Law and the anti-kickback statute. CMS proposes to create exceptions to the physician self-referral law for value-based arrangements as a way to allow physicians and other providers to try innovative value-based solutions without fear of violating the law. It would also create exceptions in certain circumstances for physicians to receive limited remuneration for items or services actually provided by the physician, allow for donations of cybersecurity technology, and amend an existing exception for electronic health records item and services.
The rule was issued on the same date as a separate Proposed Rule from the HHS OIG which proposes to add safe harbor protections under the federal anti-kickback statute for certain coordinated care and associated value-based arrangements that meet all safe harbor conditions. Other policies proposed in the HHS OIG rule include new safe harbors for donations of cybersecurity technology and electronic health records as well as safe harbors pursuant to a statutory change from the Bipartisan Budget Act of 2018 related to beneficiary incentives under the Medicare Shared Savings Program. It would additionally create a civil monetary penalties exception for certain telehealth technologies offered to patients receiving in-home dialysis.
Comments will be due 75 days after publication in the Federal Register, which is scheduled for both rules on October 17. CMS published a Fact Sheet on the rules on October 9.
Home Health Orders for Nurse Practitioners under the Maryland Total Cost of Care (TCOC) Model
On October 10, CMS published One-Time Notification Transmittal 2373, which rescinds and replaces Transmittal 2328, dated August 1, 2019, to revise BRs 11300.1 and 11330.2 to refer to Type of Bill 032x rather than 0329 in order to allow correct processing of adjustments. The transmittal is also no longer sensitive and is now posted to the internet. The original transmittal was issued regarding the allowance of all Medicare-enrolled nurse practitioners in Maryland to certify home health services for Medicare beneficiaries as part of the Maryland TCOC model.
Effective date: January 1, 2020
Implementation date: January 6, 2020
Trump Administration Touts Access to More High-Quality Medicare Plan Choices in 2020
On October 11, CMS published a Press Release regarding the star ratings for 2020 Medicare Advantage and Part D Prescription Drug Plans. Approximately 52% of Medicare Advantage plans offering prescription drug coverage in 2020 will have at least a four-star rating, up from 45% in 2019. The average star rating for all Medicare Advantage plans with prescription drug coverage improved from 4.06 in 2019 to 4.16 out of 5 for 2020.
On October 10, CMS published a Fact Sheet with more specific data on the 2020 star ratings.
Notice of New Interest Rate for Medicare Overpayments and Underpayments - 1st Qtr Notification for FY 2020
On October 11, CMS published Medicare Financial Management Transmittal 327 regarding the update to the interest rate for the first quarter of FY 2020. The new interest rate is 10.125%.
Effective date: October 18, 2019
Implementation date: October 18, 2019
MAC Guidance Related to Use of Adjustment Codes on Adjustment Claims
On October 11, CMS published Medicare Claims Processing Transmittal 4415 regarding refinements to the claims adjustment reporting process to group all claim adjustments across the MACs into three groups defining the origin of the adjustment request: CMS, MACs, or Providers. MACs are directed to use shared system codes when an adjustment directly originates from one of these three entities.
Effective date: January 1, 2020
Implementation date: January 6, 2020
Add Dates of Service for Pneumococcal Pneumonia Vaccination (PPV) HCPCS Codes (90670, 90732) and Remove Next Eligible Dates for PPV HCPCS
On October 11, CMS published One-Time Notification Transmittal 2372 regarding a process that will allow the CWF to send the date of service for PPV HCPCS codes 90670 and 90732 in separate records to the Medicare Beneficiary Database so that a provider can determine whether a beneficiary has had a first dose or second dose of a vaccination and then can differentiate between a beneficiary who is eligible for either service and those to whom services have already been rendered.
Effective date: April 1, 2020 - For all requirements except 11225.8; July 1, 2020 - For requirement 11335.8
Implementation date: April 6, 2020 - For all requirements except 11335.8; July 6 2020 - For requirement 11335.8