This week in Medicare updates—11/1/2017
CMS Ensured Medicare Shared Savings Program Beneficiaries Were Properly Assigned
On October 23, the OIG published a Report, which determined CMS complied with federal requirements when assigning beneficiaries to accountable care organizations (ACO) in the Medicare Shared Savings Program (MSSP) during PYs 2013 through 2015. CMS ensured MSSP beneficiaries were assigned to only one ACO and were not assigned to other savings programs.
Review of HHS Cancellation of Marketplace Enrollment Outreach Efforts
On October 25, the OIG published a Report on a review of the HHS cancellation of marketplace enrollment outreach before the conclusion of the fourth open enrollment period on January 31, 2017. The review was unable to determine what factors were considered in canceling outreach because HHS officials could not recall who was involved in the decision-making process.
Outreach contractor Weber Shandwick estimated canceling their outreach efforts resulted in approximately $5.2 million in recoverable costs for HHS. Outreach contractor Elevation estimated that canceling their outreach efforts resulted in approximately $400,000 in recoverable costs for HHS. Neither CMS nor HHS had any materials with a full analysis of the potential impact that canceling outreach might have on enrollment.
Federal Health Insurance Exchange 2018 Open Enrollment Fact Sheet
On October 25, CMS released a Fact Sheet on open enrollment in the federal health exchange for 2018. The release contains information on re-enrollment, window shopping, and marketing and outreach for the open enrollment period, which runs from November 1, 2017 to December 15, 2017. CMS also provided details on updates to the process, including:
- Direct enrollment using one website
- “Help On Demand” services for agents/brokers and consumers
- Updated help content in plain language to help consumers with income and eligibility questions
- Updated provider and prescription drug search
- Updated eligibility notice
Comment Request: National Provider Identifier Application, Update Form, Supporting Regulations in 45 CFR; Hospice Request for Certification Form
On October 26, CMS published a Comment Request to the Federal Register regarding the following information collections:
- National Provider Identifier Application and Update Form and Supporting Regulations in 45 CFR 142.408, 45 CFR 162.406, 45 CFR 162.408
- Hospice Request for Certification and Supporting Regulations
Comments on the above information collections are due to the OMB by November 27, 2017.
Health Outcomes After Bariatric Surgical Therapies in the Medicare Population
On October 26, CMS posted the Minutes and Transcript to the Medicare Coverage Database from a Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) meeting held on August 30, 2017. The panel examined scientific evidence for health outcomes resulting from bariatric surgery in the Medicare population for obese beneficiaries. It also discussed evidence gaps related to treatment of obesity and related co-morbidities.
Updated Civil Monetary Penalties and Affirmative Exclusions
On October 27, the OIG updated its List of Civil Monetary Penalties and Affirmative Exclusions to add three new settlements reached in October. The list includes:
- Southeast Missouri Hospital (SEM), of Cape Girardeau, Missouri, entered into a $100,000 settlement agreement with OIG on October 17 to resolve allegations that SEM failed to properly evaluate and treat two patients with unstabilized emergency medical conditions and discharged them to police custody in violation of the Emergency Medical Treatment and Labor Act.
- Shawnee Health Services (Shawnee), of Carterville, Illinois, entered into a $107,761.08 settlement agreement with OIG on October 11 to resolve allegations that Shawnee employed an individual excluded from participation in Federal healthcare programs.
- The Arkansas Department of Health (ADH) entered into a $39,343.61 settlement agreement with OIG on October 10 to resolve allegations that DH employed an individual who was excluded from participation in Federal healthcare programs.
Add Date of Receipt to the Beneficiary Data Streamlining (BDS) Part A Claims Layout
On October 27, CMS published One-Time Notification Transmittal 1945, which asks contractors to include “Date of Receipt” on the BDS Part A claim transmit record.
Effective date: April 1, 2018
Implementation date: April 2, 2018
Ambulance Inflation Factor for CY 2018 and Productivity Adjustment
On October 27, CMS published Medicare Claims Processing Transmittal 3893, which furnishes the CY 2018 ambulance inflation factor (AIF) so that Medicare contractors can accurately determine payment amounts for ambulance services. The AIF for CY 2018 is 1.1%. The 2018 ambulance fee schedule file will be available in November 2017.
Effective date: January 1, 2018
Implementation date: January 2, 2018
Next Generation ACO Model - Weekly All-Inclusive Performance Based Payment (AIPBP) Reduction File Change
On October 27, CMS published Demonstrations Transmittal 181, which introduces changes to the weekly Next Generation Accountable Care Organization (ACO) Model’s AIPBP reduction file to include the New Medicare Card Project and Medicare Beneficiary Identifier wherever a Medicare Health Insurance Claim Number is present in the file.
Effective date: April 1, 2018
Implementation date: April 2, 2018
Provider Education and Referral Reporting
On October 27, CMS published One-Time Notification Transmittal 1937 to provide instructions to Medicare contractors regarding the reporting of provider education and referrals. CMS said this information will help the agency better track and manage efforts to move toward a medical review strategy.
Effective date: November 27, 2017
Implementation date: November 27, 2017
Pulmonary Rehabilitation Services Addition to Chapter 19, Indian Health Services (IHS)
On October 27, CMS published Medicare Claims Processing Transmittal 3897, which instructs contractors to pay IHS claims containing HCPCS code G0424 when billing for pulmonary rehabilitation services as defined in Chapter 15 of the Benefit Policy Manual.
Effective date: For dates of service on or after January 1, 2010
Implementation date: April 2, 2018
Certificates of Medical Necessity (CMN) and Durable Medical Equipment Information Forms (DIF)
On October 27, CMS published Medicare Program Integrity Transmittal 753, which removes instructions in the manual to reflect that CMS no longer requires CMNs and DIFs to be two-sided. The agency will also now allow language or content to be modified when reprinted.
Effective date: November 28, 2017
Implementation date: November 28, 2017
Health Insurance Portability and Accountability Act (HIPAA) Electronic Data Interchange (EDI) Front End Updated for April 2018
On October 27, CMS published One-Time Notification Transmittal 1947 to provide the April 2018 Common Edits and Enhancements Module (CEM) edits for Part A and Part B MACs as well as for the Common Electronic Data Interchange (CEDI) contractor.
Effective date: April 1, 2018
Implementation date: April 2, 2018
Transitional Drug Add-on Payment Adjustment (TDAPA) for patients with Acute Kidney Injury (AKI)
On October 27, CMS published One-Time Notification Transmittal 1941 regarding an update to the AKI payment policy. The TDAPA policy will provide payment to End Stage Renal Disease facilities for furnishing certain calcimimetics.
Effective date: April 1, 2018
Implementation date: April 2, 2018
Common Working File (CWF) to Medicare Beneficiary Database (MBD) Extract File Changes for Detailed Skilled Nursing Facility Data to Support HIPAA Eligibility Transaction System (HETS)
On October 27, CMS published One-Time Notification Transmittal 1942 to modify the CWF to MBD extract file to separate Medicare Part A spell data into its component stays with the aim of facilitating reporting of Medicare beneficiary eligibility details via the HETS.
Effective date: April 1, 2018
Implementation date: April 2, 2018 - analysis, design, and begin coding; July 2, 2018 - complete coding, testing and implementation
Fiscal Intermediary Shared Systems (FISS) Enhancements to the Mass Adjustment of Process Recovery Audit Contractor (RAC) Claims
On October 27, CMS published One-Time Notification Transmittal 1939, which supports enhancements to the adjustment of Part A, RAC claims processed by FISS. The first enhancement will involve a system edit dealing with payment issues, and the second enhancement will add additional detail to the FISS Report 107 to ensure efficient processing claims.
The change request also updates the title of Report 107 to RAC Non-MSP Adjustments to Payments Report.
Effective date: April 1, 2018
Implementation date: April 2, 2018
Comment Request: Application for Participation in the Intravenous Immune Globulin Demonstration, Generic Clearance for Questionnaire Testing and Methodological Research for the Medicare Current Beneficiary Survey
On October 27, CMS published a Comment Request in the Federal Register regarding the following information collections:
- Application for Participation in the Intravenous Immune Globulin (IVIG) Demonstration
- Generic Clearance for Questionnaire Testing and Methodological Research for the Medicare Current Beneficiary Survey (MCBS)
Comments on the above information collections are due December 26, 2017.
Final Notice: Application from the Joint Commission for Continued Approval of its Critical Access Hospital Accreditation Program
On October 27, CMS published a Final Notice in the Federal Register to issue approval to the Joint Commission for continued recognition as a national accrediting organization for critical access hospitals that wish to participate in Medicare or Medicaid programs.
Effective date: November 21, 2017 through November 21, 2023
CMS Quarterly Listing of Program Issuances -- July through September 2017
On October 27, CMS published its Quarterly Notice of all CMS manual instructions, substantive and interpretive regulations, and other notices in the Federal Register from July through September 2017. The notice is organized into 15 addenda so that readers may access subjects published during the quarter to determine whether any are of particular interest.
The notice provides only the specific updates that have occurred in the three-month period along with a hyperlink to the full listing that is available on the CMS website.