This week in Medicare updates—11/3/2021
Provider Enrollment Application Fee Amount for Calendar Year 2022
On October 25, CMS published a Notice in the Federal Register regarding the CY 2022 application fee for institutional providers that are initially enrolling or revalidating their enrollment in Medicare, Medicaid, or CHIP or who are adding a new Medicare practice location. The fee for CY 2022 is $631.
Dates: The application fee announced in this notice is effective on January 1, 2022.
Updated Corporate Integrity Agreement Documents
On October 26, the OIG published information on new Corporate Integrity Agreements with the following entity:
CY 2022 Participation Enrollment and Medicare Participating Physicians and Suppliers Directory (MEDPARD) Procedures
On October 26, CMS published Medicare Claims Processing Transmittal 11074, which rescinds and replaces Transmittal 11043, dated October 13, to revise the effective and implementation dates.
Effective date: October 13, 2021
Implementation date: 30 days following the close of the annual participation enrollment process for BRs related to MEDPARD and the processing of participation elections and withdraws; November 15 for BRs related to disclosure reports and the MPFS; November 8 for all other requirements
FY 2022 IPPS and LTCH PPS Changes
On October 26, CMS published Medicare Claims Processing Transmittal 10995 regarding implementation of policy changes from the FY 2022 IPPS and LTCH PPS Final Rule.
CMS published MLN Matters 12373 on the same date to accompany the transmittal.
Effective date: October 1, 2021
Implementation date: October 4, 2021
New Waived Tests
On October 28, CMS published Medicare Claims Processing Transmittal 11082 regarding new CLIA-waived tests. There are three new tests included in this update.
Effective date: January 1, 2022
Implementation date: January 3, 2022
File Conversions Related to the Spanish Translation of the HCPCS Descriptions
On October 28, CMS published Medicare Claims Processing Transmittal 11090 regarding the quarterly updates to Spanish translations of HCPCS codes provided by First Coast Service Options.
Effective date: January 1, 2022
Implementation date: January 3, 2022
Decision Memo: Transvenous (Catheter) Pulmonary Embolectomy
On October 28, CMS published a Decision Memo regarding the removal of the NCD for Transvenous (Catheter) Pulmonary Embolectomy (NCD 240.6). CMS finalized its decision to remove the NCD for this procedure and will allow MACs to make coverage determinations instead.
Medicare Advantage Compliance Audit of Specific Diagnosis Codes that Coventry Health Care of Missouri, Inc., Submitted to CMS
On October 29, the OIG published a Review of whether select diagnosis codees that Coventry Health Care of Missouri, a Medicare Advantage organization, submitted to CMS for use in the risk adjustment program complied with federal requirements. The OIG conducted the audit by selecting 275 unique enrollee-years with high risk diagnosis codes for which Coventry received higher payments in 2014-2016. The OIG found that the diagnosis codes Coventry submitted for 226 of the 275 enrollee-years did not comply with federal requirements as they were not supported by the medical records. Coventry received net overpayments of $548,852 from 2014-2016 as a result of these errors.
The OIG recommended that, in addition to refunding the federal government for the $548,852 in net overpayments and identifying and returning any similar overpayments, Coventry enhance compliance procedures to focus on diagnosis codes that are at high risk for being miscoded by educating providers about the proper use and documentation of these diagnoses and determining whether these diagnoses codes comply with federal requirements. Coventry said the report contained a number of serious flaws that fundamentally undermined the audit, such as the OIG’s use of the Managed Care Manual and Risk Adjustment Training Manual as criteria rather than standards created through the proper notice-and-comment rulemaking process, and the OIG’s failure to address the actuarial equivalence principle. The OIG revised some of its findings after reviewing Coventry’s comments and revised some of its language in its recommendations but stands by its audit methodology.
Implementation of the GV Modifier for Rural Health Clinics (RHC) and Federally Qualified Health Centers (FQHC) for Billing Hospice Attending Physician Services
On October 29, CMS published Medicare Claims Processing Transmittal 11095, which rescinds and replaces Transmittal 11029, dated September 29, 2021, to revise business requirement 12357.1 and add new business requirements 12357.2, 12357.2.1, 12357.3 and 12357.3.1. The original transmittal was published regarding implementation of the GV modifier for RHCs and FQHCs to report when billing for hospice attending physician services furnished by certain RHC or FQHC practitioners during a patient’s hospice election.
CMS revised MLN Matters 12357 on the same date to accompany the transmittal.
Effective date: January 1, 2022
Implementation date: January 3, 2022
Proposal to Withdraw or Repeal Securing Updated and Necessary Statutory Evaluations Timely (SUNSET) Rule
On October 29, CMS published a Proposed Rule in the Federal Register in which it is proposing to withdraw or repeal the SUNSET final rule, which was published in the Federal Register on January 19, 2021. The rule was originally supposed to take effect in March 2021, but after a lawsuit was filed in March seeking to overturn the rule, HHS delayed the effective date until March 2022. HHS is now proposing to withdraw or repeal the final rule. The rule would have required the regulations issued by HHS would expire within specific time spans if they were not assessed or reviewed within that time.
Comments on this proposed rule are due by December 28.
ICD-10 and Other Coding Revisions to NCDs - April 2022 (CR 2 of 2)
On October 29, CMS published One-Time Notification Transmittal 11083 regarding maintenance updates of ICD-10 conversions and other coding updates for NCDs.
Effective date: April 1, 2022 - unless otherwise noted in individual requirements
Implementation date: December 2, 2021 - MACs; April 4, 2022 - Shared System Maintainers
CY 2022 End Stage Renal Disease Prospective Payment System Final Rule
On October 29, CMS published a draft copy of the 2022 ESRD PPS Final Rule, which is scheduled to be published in the Federal Register on November 8. CMS finalized updates to the outlier policy based on CY 2020 data, approved a TPNIES application for a home dialysis machine for CY 2022, and made changes to the ETC Model to incentivize providers to improve the rates of home dialysis or transplantation among beneficiaries who are dual-eligible for Medicare/Medicaid or beneficiaries who are low-income subsidy recipients.
CMS estimates payment updates in the rule will increase ESRD payments for freestanding clinics by 2.5% and increase payments for hospitals by 3.3% compared to CY 2021. The final CY 2022 ESRD PPS base rate is $257.90.
CMS published a Fact Sheet and Press Release on the rule on the same date. The regulations are effective January 1, 2022.