This week in Medicare updates—10/25/2017
Update to OIG Work Plan
On October 16, the Office of the Inspector General updated its Work Plan to include a Review of Medicare Payments for Bariatric Surgeries. The Comprehensive Error Rate Testing program found approximately 98% of improper payments for bariatric surgical procedures lacked sufficient documentation to support the procedures. The OIG says it will review supporting documentation to determine whether bariatric services met conditions for coverage and were supported in accordance with federal requirements.
Care for Dialysis Patients a Key Focus of Hurricane Maria Response Efforts in Puerto Rico
On October 17, CMS issued a Press Release highlighting the agency’s efforts to assist dialysis patients in Puerto Rico in the aftermath of Hurricane Maria. CMS said it is continuing to work with the Puerto Rico Department of Health to develop and implement a process for credentialing nurses and technicians from the mainland United States to relieve dialysis facility staff and ensure the workforce has the necessary supplies to get to and from work each day.
Additional information on CMS assistance with hurricane recovery is available on CMS’ hurricane response webpage.
Pharmacy Billing of Immunosuppressive Drugs
On October 17, CMS published Special Edition MLN Matters 17032 to supplement Medicare Claims Processing Transmittal 3856, published September 1, which updates the manual to provide clear instruction on the use of modifier -KX (requirements specified in the medical policy have been met) when billing for immunosuppressive drugs. This is the second time CMS has clarified the policy, as the agency previously published MLN Matters 10235 on September 1 to supplement Transmittal 3856.
The newest MLN Matters article re-emphasizes the importance of complying with instructions for reporting modifier -KX in light of the Office of the Inspector General’s recent determination that pharmacies did not comply with parts of the policy on a significant percentage of related claims.
Fiscal Year (FY) 2018 Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital (LTCH) PPS Changes
On October 17, CMS published Medicare Claims Processing Transmittal 3885, which rescinds and replaces Transmittal 3858, dated September 8, 2017, to revise information included in the FY 2018 update to the IPPS and LTCH PPS. The change request includes updates to the following items:
- The factor 3 denominator for hospitals treated as new
- The fixed-loss amount for LTCH standard federal payment rate cases
- Reference to the Grouper software version
- Applicable tables and files on the CMS website
- Assignment of the wage index for Indian Health Service or Tribal Hospitals of the Pricer
The change request also includes clarification on the list of ICD-10 codes eligible for the GORE IBE device system new technology add-on payment.
Effective date: October 1, 2017
Implementation date: October 2, 2017
Comment Request: New Technology Payments for APCs Under the Outpatient Prospective Payment System; Medicare Authorization to Disclose Personal Health Information
On October 18, CMS published a Comment Request in the Federal Register regarding the following information collections:
- New Technology Payments for APCs Under the Outpatient Prospective Payment System
- Medicare Authorization to Disclose Personal Health Information
Comments on the above information collections are due December 18, 2017
Outpatient Claims: Correcting Deductible and Coinsurance for Code G0473
On October 19, CMS published an MLN Connects notice regarding a systems issue with HCPCS code G0473 (face-to-face behavioral counseling for obesity, 15 minutes). Deductibles and coinsurance are incorrectly applied for that code on claims submitted via bill types 13X and 85X with a receipt date on or after January 1, 2015 and prior to the January 2018 IOCE update release.
CMS said Medicare Administrative Contractors (MACs) will mass adjust these claims within 60 days of the system update in January 2018. No action will be required from providers.
Updated Corporate Integrity Agreement Documents
On October 19, the OIG published information on a new Corporate Integrity Agreement with Digestive & Liver Disease Consultants, P.A. and Dr. Gurunath Thota Reddy of Houston, TX.
CMS Strengthens Federal Support to California Residents Affected by Wildfires
On October 19, CMS issued a Press Release stating that the agency has issued certain provisions to help meet the medical needs of the individuals, families, and facilities affected by the California wildfires. These provisions include:
- Waivers for skilled nursing facilities and assistance for hospitals and other healthcare facilities
- Special enrollment opportunities to allow eligible wildfire victims to change their Medicare health and prescription drug plans immediately
- Dialysis care for patients unable to receive dialysis services at their usual facility
- A healthcare provider hotline for Part B providers and suppliers helping with recovery efforts to use to enroll in federal health programs and receive temporary Medicare billing privileges
CMS also released Special Edition MLN Matters 17035 for providers and suppliers who submit claims to Medicare Administrative Contractors (MAC) for services provided to Medicare beneficiaries in California who were affected by the wildfires. Additional information on CMS assistance with wildfire recovery is available on CMS’ emergency webpage.
Modifications to the National Coordination of Benefits Agreement (COBA) Crossover
On October 19, CMS published One-Time Notification Transmittal 1936, which rescinds and replaces Transmittal 1876, dated July 27, 2017, to remove references of a claims receipt date from the policy section.
Effective date: January 1, 2018
Implementation date: January 2, 2018
Proof of Delivery Documentation Requirements
On October 20, CMS published Medicare Program Integrity Transmittal 750 to simplify the requirements in the manual for documenting proof of delivery. The change request also clarifies the differing oversight roles of contractors in ensuring compliance.
Effective date: November 20, 2017
Implementation date: November 20, 2017
Clarifying Signature Requirements
On October 20, CMS published Medicare Program Integrity Transmittal 751, which revises the section of the manual regarding signature requirements to clarify that the responsible party has accepted responsibility for the care of the beneficiary and authenticated related documentation. The change request also clarifies contractors responsible for fraud referrals.
Effective date: November 20, 2017
Implementation date: November 20, 2017
Clinical Laboratory Improvement Amendments (CLIA) of 1988: Fecal Occult Blood Testing
On October 20, CMS published a Final Rule in the Federal Register amending CLIA regulations to clarify that the waived test categorization applies only to non-automated fecal occult blood tests.
Effective date: December 19, 2017