This week in Medicare updates—10/18/2017
January 2018 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
On October 6, CMS published Medicare Claims Processing Transmittal 3878 and the accompanying MLN Matters 10320 to set the quarterly ASP for Medicare Part B drug pricing files for January.
Effective date: January 1, 2018
Implementation date: January 2, 2018
2018 Medicare Electronic Health Record Incentive Program Payment Adjustment Fact Sheet for Hospitals
On October 10, CMS released a Fact Sheet for hospitals on the 2018 Medicare Electronic Health Record (EHR) Incentive Program payment adjustment. The fact sheet contains information on:
- Hospital eligibility for the program
- Calculation of eligible hospital payments
- A table on the 2018 EHR eligible hospital payment adjustment
- The hardship exception application process
CMS Takes Steps to Help with Hurricane Nate Emergency Response
On October 10, CMS issued a Press Release regarding efforts to support Alabama, Florida, Louisiana, and Mississippi in the wake of Hurricane Nate. CMS is waiving or modifying certain Medicare and other healthcare requirements to provide relief to the states and geographical areas affected. Additional information on CMS assistance with hurricane recovery is available on CMS’ emergency webpage.
On October 11, CMS also released Special Edition MLN Matters 17034 for providers and suppliers who submit claims to Medicare Administrative Contractors (MAC) for services provided to Medicare beneficiaries in Alabama, Florida, Louisiana, and Mississippi who were affected by Hurricane Nate.
Updated Civil Monetary Penalties and Affirmative Exclusions
On October 11, the OIG updated its List of Civil Monetary Penalties and Affirmative Exclusions to add two settlements and one exclusion reached in September. The list includes:
- Century Pharmacy (Century), of Brooklyn, New York, reached a $10,000 settlement with the OIG on September 18 to resolve allegations that Century employed an individual who was excluded from participating in any Federal healthcare programs
- Sundance Behavioral Healthcare System (Sundance), of Texas, reached a $49,183.48 settlement with OIG on September 15 to resolve allegations that Sundance employed an individual excluded from participating in any Federal healthcare programs
- Olive Sleep & EEG, Inc., and owner Mariam Unjughulyan (collectively, “Olive Sleep”), of California, agreed on September 8 to a five-year exclusion due to the submission of claims for nerve conduction studies in violation of a Local Coverage Determination governing the medical necessity of those studies
Changes to the Laboratory National Coverage Determination (NCD) Edit Software for January 2018
On October 12, CMS published MLN Matters 10309 to accompany Transmittal 3872, published October 6, which announced changes included in the January 2018 quarterly release of the edit module for clinical diagnostic laboratory services.
Effective date: October 1, 2017
Implementation date: January 2, 2018
Notice of New Interest Rate for Medicare Overpayments and Underpayments - 1st Quarter Notification for Fiscal Year (FY) 2018
On October 12, CMS published Medicare Financial Management Transmittal 295 to update the private consumer rate to 9.750%. This rate constitutes the amount of interest CMS will apply to Overpayments and Underpayments to Medicare for the first quarter of FY 2018.
Effective date: October 18, 2017
Implementation date: October 18, 2017
Payment for Services Furnished by Qualified Nonphysician Anesthetists
On October 13, CMS published Medicare Claims Processing Transmittal 3883 to align the manual with longstanding regulations for payment of services furnished by qualified nonphysician anesthetists. The change request contains revisions to four sections of Chapter 12 of the manual as well as one deletion from Chapter 12.
Effective date: January 16, 2018
Implementation date: January 16, 2018
Clinical Laboratory Fee Schedule Not Otherwise Classified, Not Otherwise Specified, or Unlisted Service or Procedure Code Data Collection
On October 13, CMS published Medicare Claims Processing Transmittal 3881 instructing contractors to submit private payer data on unique tests currently being paid as a Not Otherwise Classified (NOC) code, Not Otherwise Specified (NOS) code, or Unlisted Service or Procedure code. The change request also contains revisions to Chapter 26 of the Medicare Claims Processing Manual to clarify how providers of service or suppliers should populate field 19 of the form when billing NOC codes.
Effective date: January 16, 2018
Implementation date: January 16, 2018
Defending Medical Review Decisions at Administrative Law Judge Hearings
On October 13, CMS published Medicare Program Integrity Transmittal 748 to update Chapter 3 (Verifying Potential Errors and Taking Corrective Actions) of the manual to reflect recent changes to the Office of Medicare Hearing and Appeals process, including but not limited to:
- Restrictions on the number of contractors able to participate during oral testimony
- Adoption of the witness role for cases in which additional support may be sought
Effective date: November 14, 2017
Implementation date: November 14, 2017