This week in Medicare updates—11/14/2018

MIPS Measures and Activities for Specific Provider Types

On November 5, CMS published a series of Fact Sheets to provide a sample of measures that apply to a variety of provider types participating in MIPS in 2018. These fact sheets were published for each of the following provider types:

• Pathologists
• Emergency Medicine Clinicians
• Ophthalmologists
• Optometrists
• Primary Care Clinicians
• Podiatrists
• Orthopedists

OIG Report finds CMS Did Not Always Ensure Hospitals Complied with Medicare Reimbursement Requirements for Graduate Medical Education (GME)

On November 5, the OIG published a Review of whether CMS ensured that hospitals in selected MAC jurisdictions claimed Medicare GME reimbursement in accordance with federal requirements. The OIG found that CMS generally ensured that hospitals in selected MAC jurisdictions claimed Medicare GME reimbursement in accordance with federal requirements, but in seven of eight audits, the OIG identified some instances of teaching hospitals that did not always comply with federal requirements. This was due to hospitals claiming GME reimbursement for residents claimed by more than one hospital for the same period, and CMS did not have adequate procedures to ensure hospitals did not count residents as more than one full-time equivalent (FTE).

The OIG recommends CMS take steps to ensure no resident is counted as more than one FTE either via implementing policies and procedures to analyze resident data and/or by requiring MACs to increase oversight as to whether residents claimed by hospitals were claimed as more than one FTE. CMS agreed with the OIG recommendations and stated it began implementing a new database for hospitals to use to collect and report information on residents.

2018 Registration Guide for the CMS Web Interface and CAHPS for MIPS Survey

On November 7, CMS published a Fact Sheet regarding the CMS Web Interface and CAHPS for MIPS survey. The fact sheet includes information about who needs to register, step-by-step instructions for how a group can register to participate in MIPS via the CMS Web Interface, and how to administer the CAHPS for MIPS survey for the 2018 performance period.

Calendar Year (CY) 2019 Participation Enrollment and Medicare Participating Physicians and Suppliers Directory (MEDPARD) Procedures

On November 8, CMS published Medicare Claims Processing Transmittal 4165, which rescinds and replaces Transmittal 4146, dated October 19, 2018, to attach the Dear Doc Letter. The transmittal is no longer sensitive and may be posted to the internet. The original transmittal was issued regarding information needed for 2019 participation enrollment.

Effective date: November 19, 2018 - Upon Issuance of this Instruction

Implementation date: October 19, 2018 - 30 days following the close of the annual participation enrollment process for BR 10942.18; 11/14/2018 for BRs 10942.2, 10942.2.1, 10942.3, 10942.4, 10942.5, 10942.11, 10942.13, 10942.13.1, 10942.14; 11/08/2018 for all other requirements.

ICD-10 and Other Coding Revisions to National Coverage Determinations (NCD)

On November 8, CMS published One-Time Notification Transmittal 2200, which rescinds and replaces Transmittal 2138, dated September 18, 2018, to add ICD-10 dx H35.52 and remove H35.53 from NCD80.11, remove ICD-10 dx D61.1 from the NCD110.21 non-covered list, and correct NCD220.6.17 spreadsheet dx tab to align with requirements by removing ICD-10 dx C4A.12 and adding C4A.21. In addition, this correction revises business requirements 10859.1.1.1.1 and 10859.2 as well as the implementation date. The original transmittal was issued regarding the maintenance update of ICD-10 conversions and other coding updates specific to NCDs.

Effective date: January 1, 2019 - Unless otherwise noted in requirements

Implementation date: January 7, 2019 - for shared system edits. Exception: MCS to implement addition of ICD-10 H35.52, removal of ICD-10 H35.53 from NCD80.11 April 1, 2019, with CR11005. FISS & MCS to implement removal of ICD-10 D61.1 from NCD110.21 April 1, 2019, with CR11005. Local MAC edits September 28, 2018. Exception: Edits included in NCD110.21, NCD80.11: 30 days from issuance of this CR.