This week in Medicare updates—11/18/2020
CLIA CMS Locations and State Agency Remote Survey Guidance - Optional Process
On November 6, CMS published a Memorandum to state survey agencies and directors regarding an optional remote survey process for the PHE. Due to the COVID-19 pandemic, there is a backlog of laboratories who need to be surveyed. CMS is providing a way for state agencies to perform remote CLIA surveys whenever possible for recertification surveys and some re-visits that may be necessary. The memo details the process, which is an optional process and will only be permitted for recertifications when laboratories have a good compliance history.
Effective date: Immediately. This policy should be communicated with all survey and certification staff, their managers, and the state/regional office training coordinators within 30 days of this memo.
2021 Medicare Parts A & B Premiums and Deductibles
On November 6, CMS published a Fact Sheet and Press Release regarding the 2021 Medicare Parts A & B premiums, deductibles, and coinsurance amounts. These rates increased in both Part A and B from 2020 to 2021. The standard 2021 amounts are:
- Part A inpatient hospital deductible - $1,484
- Increased $76 from 2020 rate
- Part A daily coinsurance (61st - 90th day) - $371
- Increased $19 from 2020 rate
- Part A daily coinsurance (lifetime reserve days) - $742
- Increased $38 from 2020 rate
- Part B monthly premium - $148.50
- Increased $3.90 from 2020 rate
- Part B annual deductible - $203
- Increased $5 from 2020 rate
- Skilled nursing facility coinsurance - $185.50
- Increased $9.50 from 2020 rate
CMS published these rates in the Federal Register on November 12 via separate notices for the CY 2021 Inpatient Hospital Deductible and Hospital and Extended Care Services Coinsurance Amounts, the CY 2021 Part A Premiums for the Uninsured Aged and Certain Disabled Individuals Who Have Exhausted Other Entitlements, and the CY 2021 Part B Monthly Actuarial Rates, Premium Rates, and Annual Deductible.
Implementation of Changes in the End-Stage Renal Disease (ESRD) PPS and Payment for Dialysis Furnished for Acute Kidney Injury (AKI) in ESRD Facility for CY 2021
On November 6, CMS published Medicare Benefit Policy Transmittal 10451 regarding implementation of the 2021 rate updates and policies for the ESRD PPS. Changes include paying for calcimimetics through the ESRD PPS base rate rather than TDAPA, clarification on the low-volume payment adjustment, and more.
On November 9, CMS published MLN Matters 12011 to accompany the transmittal.
Effective date: January 1, 2021
Implementation date: January 4, 2021
Home Health Prospective Payment System (HH PPS) Rate Update for CY 2021
On November 6, CMS published Medicare Claims Processing Transmittal 10439 regarding updates to the HH PPS rates for CY 2021. This includes changes to the 30-day base payment rates, national per-visit amounts, amounts for calculating outlier payments, and more.
On November 9, CMS published MLN Matters 12017 to accompany the transmittal.
Effective date: January 1, 2021
Implementation date: January 4, 2021
Internet Only Manual Update, Pub. 100-04, Chapter 11
On November 9, CMS published Medicare Claims Processing Transmittal 10453, which rescinds and replaces Transmittal 10407, dated October 10, to revise the IOM manual to delete the reference to subsection 110 of the manual. The original transmittal was issued regarding updates to manual language pertaining to notice of termination/revocation for hospice discharges, valid discharge status codes for hospice, and more.
Effective date: September 7, 2020
Implementation date: December 1, 2020
Comment Request: Results of Your Drug Coverage Request; Medicare Advantage, Medicare Part D, and Medicare Fee-for-Service CAHPS Survey
On November 9, CMS published a Comment Request in the Federal Register regarding the following information collections:
- Results of Your Drug Coverage Request
- Medicare Advantage, Medicare Part D, and Medicare Fee-for-Service Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey
Comments are due by January 8, 2021.
Request for Renewal of Deeming Authority of the National Committee for Quality Assurance (NCQA) for Medicare Advantage Health Maintenance Organizations and Preferred Provider Organizations
On November 9, CMS published a Notice with Request for Comment in the Federal Register to announce it is considering granting approval of the National Committee for Quality Assurance’s (NCQA) renewal application for Medicare Advantage deeming authority of HMOs and PPOs. There will be a 30-day public comment period on the application, and if approved, NCQA would receive a 6-year deeming authority term.
Dates: Comments must be received at one of the addresses provided in the notice no later than 5 p.m. on December 9, 2020.
Application from The Joint Commission for Continued Approval of its Hospice Accreditation Program
On November 9, CMS published a Notice with Request for Comment in the Federal Register to announce it has received an application from The Joint Commission for continued recognition as a national accrediting organization for hospices that wish to participate in Medicare or Medicaid.
Dates: Comments on the application must be received at one of the addresses provided in the notice no later than December 9, 2020.
Medicare Monoclonal Antibody COVID-19 Infusion Program Instruction
On November 10, CMS published a Press Release to announce it will cover and pay for a new COVID-19 monoclonal antibody infusion, bamlanivimab, when furnished consistent with an Emergency Use Authorization (EUA) granted by the FDA on November 9. This policy is effective immediately. Medicare beneficiaries will be able to receive the infusion without having to pay any copayment, coinsurance, or deductible. The product will initially be available to health care providers for no charge, and Medicare will not pay for antibody products that providers receive for free. However, when healthcare providers begin to purchase these products, Medicare anticipates setting payment for it in the same way it will set the payment rates for COVID-19 vaccines. There are also two codes available for the injection of bamlanivimab (Q0239) and the IV infusion/post-infusion monitoring of bamlanivimab (M0239).
CMS published a Program Instruction on the same date regarding the current coding and billing information for the product, and a Fact Sheet on the limitations of the EUA.
FAQs: CLIA Guidance During the COVID-19 Emergency
On November 10, CMS updated an FAQ regarding CLIA guidance during the COVID-19 PHE. The document addresses a variety of questions about waivers, remote testing, certification, payment information, and more. It also includes a wide variety of links to guidance issued at various times throughout the PHE on topics pertaining to CLIA labs.
Comment Request: Hospital and Health Care Complex Cost Report
On November 10, CMS published a Comment Request in the Federal Register regarding an information collection titled “Hospital and Health Care Complex Cost Report.”
Comments are due by January 11, 2021.
Updated List of Excluded Individuals and Entities (LEIE)
On November 10, the OIG updated its LEIE with an updated LEIE database for download and lists of October 2020 exclusions, reinstatements, and profile corrections.
Changes to the ESRD PRICER to Accept the New Outpatient Provider Specific File Supplemental Wage Index Fields, the Network Reduction Calculation and New Value Code for Time on Machine
On November 10, CMS published One-Time Notification Transmittal 10368, which rescinds and replaces Transmittal 10268, dated August 6, to revise business requirement 11871.7. This transmittal is no longer sensitive and is now being posted to the internet. The original transmittal was issued regarding system changes to implement the new supplemental wage index fields in the outpatient provider specific file and the new value code required for reporting minutes of dialysis provided during the billing period.
Effective date: January 1, 2021
Implementation date: January 4, 2021
Implementation of the Transitional Add-on Payment Adjustment for New and Innovative Equipment and Supplies (TPNIES) under the ESRD PPS
On November 10, CMS published Medicare Claims Processing Transmittal 10399, which rescinds and replaces Transmittal 10267, dated August 6, to include revised recurring update numbers in business requirements 11869.9 and 11869.9.1. This transmittal is no longer sensitive and is now being posted to the internet. The original transmittal was issued regarding system changes for implementing TPNIES in the ESRD PPS and to establish a quarterly recurring update for HCPCS codes eligible for TPNIES.
Effective date: January 1, 2021
Implementation date: January 4, 2021
HHS Telehealth Guidance and Information Website
On November 12, CMS published a link to an HHS Website created for both patients and providers regarding telehealth during the PHE. The provider page has a variety of information on policy changes, billing and reimbursement, and legal considerations pertaining to telehealth services.
COVID-19 Vaccine Codes and PC-ACE Software Update
On November 12, CMS published Special Edition MLN Connects regarding updates to the PC-ACE software in preparation for COVID-19 vaccine administration claims and roster billing for the vaccine and/or the new monoclonal antibody product (bamlanivimab).
Updated Corporate Integrity Agreement Documents
On November 12, the OIG published information on new Corporate Integrity Agreements with the following entities:
- Essex Group Management Corp. and Claflin Hill Corporation and Dartmouth House Nursing Home, Inc., and St. John's Nursing Home, Inc., and Erlin Manor Nursing Home, Inc., and Westside Corporation, and Houghton Corporation, of Rowley, MA
- eClinicalWorks, LLC, of Westborough, MA
Implementation of the Award for the Jurisdiction C Durable Medical Equipment MAC
On November 13, CMS published One-Time Notification Transmittal 10462 to announce the JC DME MAC workload has been awarded to CGS Administrators, LLC, the incumbent contractor for the workload.
Effective date: January 1, 2021
Implementation date: January 4, 2021
Updates to Pub. 100-09, Beneficiary and Provider Communication Manual, Chapter 6, Provider Customer Service Program
On November 13, CMS published Medicare Contractor Beneficiary and Provider Communications Transmittal 10455 regarding a variety of updates to Chapter 6 of the manual. These include updating links and references, adding social media reporting requirements, clarifying language about what inquiries are covered by the DDR, and more.
Effective date: December 16, 2020
Implementation date: December 16, 2020
Billing for Home Infusion Therapy Services On or After January 1, 2021
On November 13, CMS published Medicare Benefit Policy Transmittal 10463 and Medicare Claims Processing Transmittal 10463, which rescinds and replaces Benefit Policy Transmittal 10269 and Claims Processing Transmittal 10269, dated August 7, to revise BR 11880.04.3 and to add BRs 11880.04.2.2 through 11880.04.2.11 in the Claims Processing Manual only. This correction doesn’t change any instructions in the Benefit Policy Manual. In addition, this correction adds a new Attachment B titled “Home Infusion Therapy (HIT) Services Payment File Layout.” The original transmittals were issued regarding billing guidance and changes to claims processing systems in preparation for the implementation of the new home infusion therapy benefit.
On August 10, CMS published MLN Matters 11880 to accompany the transmittals.
Effective date: January 1, 2021
Implementation date: January 4, 2021
Update to Chapter 10 of Pub. 100-08 - Enrollment Policies for Home Infusion Therapy (HIT) Suppliers
On November 13, CMS published Medicare Program Integrity Transmittal 10467, which rescinds and replaces Transmittal 10434, dated October 30, to revise business requirement 11954.5.3 and to add additional updates to the manual. The original transmittal was issued regarding the policies and procedures for enrolling HIT suppliers in Medicare.
CMS published MLN Matters 11954 on the same date to accompany the transmittal.
Effective date: January 1, 2021
Implementation date: November 1, 2020
Direct Mailing Notification to Hospice Providers Regarding the Hospice Benefit Component, Value-Based Insurance Design (VBID) Model, for Participating Medicare Advantage Organizations (MAOs)
On November 13, CMS published One-Time Notification Transmittal 10458 regarding information about a direct mailing MACs will be sending to hospice providers. The mailing will raise awareness of the hospice benefit component and will provide education on participation and billing for Medicare Advantage enrollees who receive services in affected areas.
Effective date: December 16, 2020
Implementation date: December 16, 2020
National Coverage Determination (NCD 110.24): Chimeric Antigen Receptor (CAR) T-Cell Therapy
On November 13, CMS published Medicare Claims Processing Transmittal 10454 and National Coverage Determinations Transmittal 10454 regarding implementation of NCD 110.24: CAR T-Cell Therapy. This coverage determination is effective for claims with dates of service on or after August 7, 2019, when CAR T-Cell therapy is administered at healthcare facilities enrolled in the FDA Risk Evaluation and Mitigation Strategies (REMS) and the case meets specified FDA conditions. The Claims Processing Transmittal contains billing information, such as revenue codes, HCPCS codes, diagnosis codes, and more to use when billing for this service.
Effective date: August 7, 2019
Implementation date: February 16, 2021
Update to Vaccine Services Editing
On November 13, CMS published Medicare Claims Processing Transmittal 10456 regarding modifications to edits to fix an issue where inpatient SNF claims on TOB 21X were being denied when dates of service overlapped a previously processed outpatient vaccine or telehealth service (on TOB 12X) for the same beneficiary. The change request also instructs contractors to pay HCPCS codes G0008, G0009, and G0010 based on the CY 2019 national payment amounts for immunization administration services.
Effective date: April 1, 2021 - For claims received on or after this date
Implementation date: April 5, 2021