This week in Medicare updates—1/16/2019
Local Coverage Determinations (LCD)
On January 11, CMS published Medicare Program Integrity Transmittal 854, which rescinds and replaces Transmittal 829, dated October 3, 2018, to update three business requirements and their related Chapter 13 manual instructions. The changes add language indicating that MACs have the discretion to host multi-jurisdictional Contractor Advisory Committees, and they strike some language in other sections. The original transmittal was issued regarding revisions to Chapter 13 of the Program Integrity Manual to simplify the LCD process and increase transparency.
CMS published a revised MLN Matters 10901 on the same date to accompany the transmittal.
Effective date: September 26, 2018
Implementation date: January 8, 2019 - unless otherwise specified.
Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edit, Version 25.1 Effective April 1, 2019
On January 11, CMS published Medicare Claims Processing Transmittal 4193 regarding the quarterly update to the NCCI PTP edits.
Effective date: April 1, 2019
Implementation date: April 1, 2019
Quarterly Update for the Temporary Gap Period of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP) - April 2019
On January 11, CMS published Medicare Claims Processing Transmittal 4192 regarding quarterly updates to the DMEPOS CBP files. These file updates implement changes to HCPCS codes, zip codes, the single payment amount, and supplier files.
Effective date: April 1, 2019
Implementation date: April 1, 2019
New Waived Tests
On January 11, CMS published Medicare Claims Processing Transmittal 4195 regarding 14 newly added waived complexity tests. The CPT codes, effective dates, and descriptions for these tests are listed in the transmittal. Modifier QW must be appended to these codes to be recognized as a waived test.
CMS published MLN Matters 11080 on the same date to accompany the transmittal.
Effective date: April 1, 2019
Implementation date: April 1, 2019
Update to Publication 100-04 Chapter 25 to Provide Language-Only Changes for the New Medicare Card Project
On January 11, CMS published Medicare Claims Processing Transmittal 4194 regarding changes to the manual to update language related to the new Medicare cards.
Effective date: February 12, 2019
Implementation date: February 12, 2019
Chapter 30 Revisions in Publication 100-04, Medicare Claims Processing Manual
On January 11, CMS published Medicare Claims Processing Transmittal 4197 regarding revisions to Chapter 30 of the manual for a section on financial liability protections, limitations on liability, refund requirements for non-assigned claims for physicians services, and refund requirements for assigned and non-assigned claims for medical equipment and supplies. These changes also include the addition of a glossary to aid readers with common terminology found in the chapter.
CMS published MLN Matters 10848 on the same date to accompany the transmittal.
Effective date: April 15, 2019
Implementation date: April 15, 2019
Skilled Nursing Facility Advance Beneficiary Notice of Non-Coverage (SNF ABN)
On January 11, CMS published Medicare Claims Processing Transmittal 4198, which rescinds and replaces Transmittal 4011, dated March 30, 2018, to remove multiple sections/subsections in Chapter 30 of the manual and to revise eight other subsections in the same chapter. These sections should have been removed or revised in the previous transmittal. The original transmittal was issued to revise the SNF ABN Form CMS-10055.
CMS published a revised MLN Matters 10567 on the same date to accompany the transmittal.
Effective date: April 30, 2018 - Please note that SNFs may start to implement this new notice any time up to the effective date, which will then be mandatory for use.
Implementation date: April 30, 2018 - Please note that SNFs may start to implement this new notice any time up to the implementation date, which will then be mandatory for use.
2019 Durable Medical Equipment Prosthetics, Orthotics, and Supplies HCPCS Code Jurisdiction List
On January 11, CMS published Medicare Claims Processing Transmittal 4200 regarding the annual update to the HCPCS code list for Durable Medical Equipment MACs and Part B MACs. These updates reflect codes that have been added or deleted for the year.
CMS published MLN Matters 11085 on the same date to accompany the transmittal.
Effective date: January 1, 2019
Implementation date: February 12, 2019
Clinical Laboratory Fee Schedule - Medicare Travel Allowance Fees for Collection of Specimens
On January 11, CMS published Medicare Claims Processing Transmittal 4199 regarding revisions to the payment of travel allowances for calendar year 2019. Payment on a per mileage basis for code P9603 will be $1.03 per mile or higher based on the discretion of the contractor. Payment for a flat-rate trip under code P9604 will be $10.30.
Effective date: January 1, 2019
Implementation date: February 12, 2019 - or sooner
Notice of New Interest Rate for Medicare Overpayments and Underpayments - 2nd Qtr Notification for FY 2019
On January 11, CMS published Medicare Financial Management Transmittal 310 regarding the quarterly change in interest rate for overpayments and underpayments. The private consumer rate has been changed to 10.75% for the second quarter of FY 2019.
Effective date: January 17, 2019
Implementation date: January 17, 2019