This week in Medicare updates—12/18/2018
Transition to New Medicare Numbers and Cards
On December 10, CMS published a Fact Sheet regarding the transition to new Medicare numbers and cards. The fact sheet addresses what providers should do to prepare for the change, what the new Medicare Beneficiary Identifier (MBI) will look like, and how providers should use the MBI on claims.
Alternative Payment Models in the Quality Payment Program as of November 2018
On December 10, CMS published a List of APMs that CMS currently operates or has announced as of November 2018. The list identifies whether each APM qualifies as a MIPS APM and whether each APM meets certain other criteria.
CMS Web Interface Data Submission Frequently Asked Questions
On December 12, CMS published an FAQ regarding the CMS Web Interface method of data submission for the Quality Payment Program. The FAQ addresses topics such as sampling and pre-population, abstraction into the CMS web interface, handling at-risk populations, and more.
National Coverage Determination (NCD) 20.4 Implantable Cardiac Defibrillators (ICDs)
On December 13, CMS published Medicare National Coverage Determinations Transmittal 211, which rescinds and replaces Transmittal 209, dated November 21, 2018, to add a clarifying note to the policy section of the business requirements document that was inadvertently left out. The original transmittal was issued regarding changes to NCD 20.4, Implantable Cardiac Defibrillators, that will increase coverage of ICDs for six patient indications as listed in the transmittal.
Effective date: February 15, 2018
Implementation date: February 26, 2019 - of this CR - MAC local edits
Medical Review of Diagnostic Laboratory Tests
On December 14, CMS published Medicare Program Integrity Transmittal 850, which rescinds and replaces Transmittal 836, dated October 19, 2018, to revise business requirement 10908.1 to include all options of how a contractor will consider order requirements met when doing medical review of laboratory claims, and to change the effective and implementation dates to allow contractors additional time for implementation. The original transmittal was issued regarding instructions to medical review contractors on how to review orders for diagnostic laboratory tests.
Effective date: December 17, 2018 - Reviews conducted on/after 30 days from issuance
Implementation date: December 17, 2018 - Reviews conducted on/after 30 days from issuance
CY 2019 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment
On December 14, CMS published Medicare Claims Processing Transmittal 4182 regarding instructions for the CY 2019 clinical lab fee schedule, mapping for new codes for clinical lab tests, and updates for lab costs subject to the reasonable charge payment.
Effective date: January 1, 2019
Implementation date: January 7, 2019
Updates to the Inpatient Psychiatric Facility (IPF) Benefit Policy Manual
On December 14, CMS published Medicare Benefit Policy Transmittal 253 regarding updates to the IPF Benefit Policy Manual to reflect changes made in the FY 2019 IPF Prospective Payment System final rule. These changes add language from existing regulations, make technical corrections, clarify language, and update language in certain places, but none of these updates constitutes a change from existing policy.
Effective date: January 16, 2019
Implementation date: January 16, 2019