This week in Medicare updates—10/9/2019
Comment Request: Hospital Survey for Specified Covered Outpatient Drugs
On September 30, CMS published a Comment Request in the Federal Register regarding an information collection titled, “Hospital Survey for Specified Covered Outpatient Drugs (SCODs).” Comments are due by November 29, 2019.
Performance Review Board Membership
On September 30, CMS published a Notice in the Federal Register to announce the appointment of board members to serve on the Senior Executive Service Performance Review Boards for CMS.
Clinical Laboratory Improvement Amendments of 1988 (CLIA) Exemption of Laboratories Licensed by the State of Washington
On September 30, CMS published a Notice in the Federal Register to announce that laboratories located in and licensed by the state of Washington that possess a valid license under the Medical Test Site Law are exempt from CLIA requirements for four years.
Dates: The exemption takes effect on September 30, 2019 and runs through October 2, 2023.
Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) Updates for FY 2020
On October 1, CMS published Medicare Claims Processing Transmittal 4406, which rescinds and replaces Transmittal 4357, dated August 9, 2019, to revise business requirement 11420.2 to show an October 1, 2019 effective date instead of a September 30, 2019 effective date. The original transmittal was issued regarding changes required as part of the annual IPF PPS update. This includes changes to payment factors and to the pricer.
On October 2, CMS revised MLN Matters 11420 to accompany the transmittal.
Effective date: October 1, 2019
Implementation date: October 7, 2019
Integrated Data Repository (IDR) Weekly Scheduled Full Provider Master File (PMF) Extracts
On October 3, CMS published One-Time Notification Transmittal 2367, which rescinds and replaces Transmittal 2345, dated September 6, 2019, to include unique header and trailer definitions in the file layout attachment. The original transmittal was issued regarding instructions for the shared systems maintainer to send extracts of the PMF to the IDR for Part A, Part B, and Durable Medical Equipment MACs.
Effective date: January 6, 2020
Implementation date: January 6, 2020
Implementation of the Skilled Nursing Facility (SNF) Patient-Driven Payment Model (PDPM)
On October 3, CMS published One-Time Notification Transmittal 2366, which rescinds and replaces Transmittal 2299, dated May 3, 2019, to add new business requirement 11152.11 and a new HIPPS code file attachment. The original transmittal was issued regarding the implementation of PDPM.
CMS revised MLN Matters 11152 on October 4 to accompany the transmittal.
Effective date: October 1, 2019
Implementation date: July 1, 2019 - CWF and FISS Coding and Testing in July 2019; July 1, 2019 - CWF Implementation in July; October 1, 2019 - Pricer updates and continue testing
Executive Order on Protecting and Improving Medicare for Our Nation’s Seniors
On October 3, President Trump issued an Executive Order regarding a broad range of Medicare topics. The directives include approaches to adding benefit enhancements that would encourage seniors more toward Medicare Advantage than fee-for-service Medicare; reducing potentially burdensome billing requirements, conditions of participation, supervision requirements, and licensure requirements; expediting processes to bring innovative technologies to the market faster; changing pricing/payment structures to align them more closely to prices from the commercial market; and reviewing policies to possibly reduce disparities in reimbursement based on provider type. Most directives were given deadlines for one year from now, meaning proposals on these topics would be due one month ahead of the 2020 general election.
Reminder - Medicare Provides Coverage of Diabetes Screening Tests
On October 3, CMS published a revised version of Special Edition MLN Matters 0821 to show that that ICD-10 code, Z13.1, would be reported for services on or after October 1, 2015. The original article was published providing information on Medicare payments for diabetes screening tests.
Comment Request: Contract Year 2021 Plan Benefit Package (PBP) Software and Formulary Submission; Administrative Simplification HIPAA Compliance Review
On October 4, CMS published a Comment Request in the Federal Register regarding the following information collections:
- Contract Year 2021 Plan Benefit Package (PBP) Software and Formulary Submission
- Administrative Simplification HIPAA Compliance Review
Comments are due by December 3, 2019.
October 2019 Update of the Ambulatory Surgical Center (ASC) Payment System
On October 4, CMS published Medicare Claims Processing Transmittal 4410, which rescinds and replaces Transmittal 4389, dated September 6, 2019, to correct table 1 attachment A to reinstate C9043 rather than delete it effective October 1, 2019, revise corresponding footnote 1, and delete footnote 2. File names have been corrected for BR11457.1 and BR11457.2. The original transmittal was issued regarding the October update of the ASC payment system, which included 20 new HCPCS codes for separately payable drugs and biologicals, one status indicator change for the April 1, 2019 through June 30, 2019 period, one status indicator change for the July 18, 2019 through September 30, 2019 period, and more.
On September 9, CMS published MLN Matters 11457 to accompany the transmittal.
Effective date: October 1, 2019
Implementation date: October 7, 2019
Manual Updates for CR11152 Implementation of the Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM)
On October 4, CMS published Medicare General Information, Eligibility, and Entitlement Transmittal 126, Medicare Benefit Policy Transmittal 261, and Medicare Claims Processing Transmittal 4409 regarding manual updates made as part of the implementation of the SNF PDPM. The Claims Processing Manual update includes many changes to Chapter 6 of the manual with a variety of new guidance following the implementation of PDPM. The Benefit Policy Manual features a variety of new guidance pertaining to PDPM in Chapters 3 and 8 of the manual.
Effective date: November 5, 2019
Implementation date: November 5, 2019
The Medicare Fee-for-Service Recovery Audit Program
On October 4, CMS published Medicare Program Integrity Transmittal 908 and Medicare Financial Management Transmittal 326 regarding moving the instructions for the Recovery Audit program from the Financial Management Manual to the Program Integrity Manual. Chapter 4, Section 100 of the Financial Management Manual will now be located in Chapter 9 of the Program Integrity Manual.
Effective date: November 5, 2019
Implementation date: November 5, 2019
Update to Chapter 3, Section 3.2.3.1 Additional Documentation Requests (ADR) of Publication 100-08
On October 4, CMS published Medicare Program Integrity Transmittal 907 regarding instructions to MACs and RACs who request additional documentation to perform prepayment and post payment reviews utilizing an eMDR via the esMD.
Effective date: January 1, 2020
Implementation date: January 6, 2020
Ambulance Inflation Factor for Calendar Year (CY) 2020 and Productivity Adjustment
On October 4, CMS published Medicare Claims Processing Transmittal 4407 to manualize the ambulance inflation factor so contractors can determine payment amounts for ambulance services. The 2020 ambulance fee schedule file should be available in November 2019.
Effective date: January 1, 2020
Implementation date: January 6, 2020
Implementation for First Coast Service Options (FCSO) and Novitas for the CMS Enterprise Identity Management OKTA/Saviynt Migration
On October 4, CMS published One-Time Notification Transmittal 2369 regarding instructions for FCSO JN and Novitas JH and JL to migrate from Enterprise Identity Management to the CMS Identity Management OKTA/Saviynt by March 31, 2020. This is continued analysis and implementation of CR 10791.
Effective date: March 31, 2020
Implementation date: March 31, 2020