This week in Medicare updates—1/26/2022
Comment Request: Prepaid Health Plan Cost Report; The PACE Organization Application Process in 42 CFR Part 460
On January 18, CMS published a Comment Request in the Federal Register regarding the following information collections:
- Prepaid Health Plan Cost Report
- The PACE Organization Application Process in 42 CFR Part 460
Comments are due by March 21, 2022.
Updated OIG Work Plan
On January 18, the OIG updated its Work Plan with the following new items:
- Nationwide Review of Hospice Beneficiary Eligibility
- Followup Audit on CMS's Use of Medicare Data To Identify Instances of Potential Abuse or Neglect
- Medicare Administrative Contractor Cost Report Oversight - Contract Review
- Mandatory Review of HHS Agencies Annual Accounting of National Drug Control Program Funds
CMS Should Take Further Action to Address States with Poor Performance in Conducting Nursing Home Surveys
On January 18, the OIG published a Report on CMS oversight of state performance in conducting nursing home surveys from FYs 2015-2018. The OIG found that over half of states nationwide failed to meet the same performance measure(s) in three or four consecutive years during the audit period. The most commonly missed performance measure was related to survey timeliness. CMS relied on corrective action plans, training, and informal communication to improve state performance, but 10% of corrective action plans were missing from CMS files and many lacked substantive details. CMS also sometimes imposed financial penalties on states when those states failed to meet the timeliness requirement for surveys, but those penalties were frequently offset with one-time funding adjustments.
The OIG recommends CMS actively monitor states’ corrective action plans, establish guidelines for progressive enforcement actions, engage with senior state officials earlier and more frequently to address problems, and revise the State Operations Manual to reflect current CMS oversight practices. CMS concurred with these recommendations. The OIG also recommended CMS disseminate results of state performance reviews more widely than CMS’ current method.
Extension of Timeline for Publication of Final Rule: CLIA Proficiency Testing Regulations Related to Analytes and Acceptable Performance
On January 19, CMS published an Extension Notice in the Federal Register to announce that it is extending the timeline for publishing an final rule on CLIA proficiency testing regulations related to analytes and acceptable performance. The proposed rule was published on February 4, 2019, but CMS is extending publication of a final rule until February 4, 2023 due to the COVID-19 PHE.
Dates: The timeline for publication of the final rule to finalize the provisions of the proposed rule published on February 4, 2019, is extended until February 4, 2023.
Omnibus COVID-19 Health Care Staff Vaccination Rule: Texas Injunction Lifted
On January 20, CMS published a Memorandum to state survey agency directors on enforcement actions and survey directives to ensure compliance with the Omnibus COVID-19 Health Care Staff Vaccination Rule in Texas after a federal judge in Texas dismissed the state’s challenge to the rule and lifted the injunction against it. CMS posted Download Links for provider-specific guidance on compliance with the rule on the same date.
Effective date: This policy should be communicated with all survey and certification staff, their managers, and the State/CMS Location training coordinators immediately. The effective dates of the specific actions are specified in the memo.
Updating the 32287 Reason Code Edit in the FISS to Allow Processing of Claims Containing HCPCS Code Q0249
On January 20, CMS published One-Time Notification Transmittal 11192 regarding a change to FISS reason code edit 32287 to allow processing of claims containing HCPCS code Q0249 (COVID-19 monoclonal antibody injection, tocilizumab) when the number of units on the claim is greater than one.
Effective date: July 1, 2022 - Claims processed on or after this date
Implementation date: July 5, 2022
ESRD Treatment Choices (ETC) Model Demo Priorities Correction
On January 20, CMS published Demonstrations Transmittal 11201 regarding a correction to edits to prevent any VA claims (demo code 31) from being included in the ETC model (demo code 94).
Effective date: July 1, 2022
Implementation date: July 5, 2022
Modify FISS Existing Logic for Vaccine Administration Codes for Non-OPPS Island Providers
On January 20, CMS published One-Time Notification Transmittal 11204 regarding modifications to the logic in the FISS to allow claims submitted by island providers containing vaccine administration codes to process when pricing indicator “B” is present.
Effective date: February 28, 2022 - Unless otherwise specified, the effective date is by the receipt date (This CR is using July 2022 hours)
Implementation date: February 28, 2022 - This CR is using July 2022 hours
Correction to Processing When Osteoporosis Drugs are Billed for Other Indications
On January 20, CMS published One-Time Notification Transmittal 11190 regarding the removal of an edit that only allowed osteoporosis drug HCPCS codes to be billed by home health agencies. CMS has identified instances where calcitonin, an osteoporosis drug, may be used for other indications and would therefore be used in other locations.
Effective date: July 1, 2022 - Claims received on or after this date
Implementation date: July 5, 2022
Internet-Only Manual Updates for Critical Care Evaluation and Management Services
On January 20, CMS published Medicare Claims Processing Transmittal 11195 regarding updates to the Claims Processing Manual to incorporate policies finalized in the CY 2022 MPFS Final Rule for critical care E/M services.
Effective date: January 1, 2022
Implementation date: February 22, 2022
NCD 270.3 Blood-Derived Products for Chronic, Non-Healing Wounds
On January 20, CMS published Medicare Claims Processing Transmittal 11214 and Medicare National Coverage Determinations Transmittal 11214, which rescind and replace Claims Processing Transmittal 11171 and National Coverage Determinations Transmittal 11171, dated January 12, to provide clarification to the note in the Claims Processing Manual BRs 12403.04-01 and to update the title for the NCD 270.3 Blood Derived Products for Chronic Non-healing Wounds attachment. All changes are associated with the Claims Processing Manual only. The original transmittal was published regarding implementation for coverage of autologous platelet-rich plasma (PRP) infusions for the treatment of chronic non-healing diabetic wounds.
CMS revised MLN Matters 12403 to accompany the transmittals.
Effective date: April 13, 2021
Implementation date: January 3, 2022 - Shared Systems; February 14, 2022 - for MACs
HCPCS Codes Subject to and Excluded from Clinical Laboratory Improvement Amendments (CLIA) Edits
On January 20, CMS published Medicare Claims Processing Transmittal 11208 regarding updates to the HCPCS codes for 2022 that are subject to and excluded from CLIA edits.
CMS published MLN Matters 12573 on the same date to accompany the transmittal.
Effective date: April 1, 2022
Implementation date: April 4, 2022
Prevent Loading of Dental HCPCS Codes in the FISS
On January 20, CMS published One-Time Notification Transmittal 11194 regarding changes to the contractor file load process so that dental codes are no longer added to the contractor file and thereby preventing MACs from having to manually update the Type of Service and code descriptions to restore the IRF HIPPS code information after each quarterly contractor file update.
Effective date: July 1, 2022 - Claims received on or after this date
Implementation date: July 5, 2022
New Occurrence Span Code and Revenue Code for Acute Care Hospital Care at Home
On January 20, CMS published One-Time Notification Transmittal 11191 regarding new Occurrence Span Code 82 (Hospital at Home Care Dates) and new Room and Board (R&B) Revenue Code Subcategory 0161 (Hospital at Home, R&B/Hospital at Home), which will be used to identify and track inpatient claims submitted for beneficiaries receiving acute hospital care services at home.
Effective date: July 1, 2022 - For claims received on or after July 1, 2022
Implementation date: July 5, 2022
Comment Request: Medicare Current Beneficiary Survey (MCBS); Application and Triennial Re-application to Be a Qualified Entity to Receive Medicare Data for Performance Measurement
On January 21, CMS published a Comment Request in the Federal Register regarding the following information collections:
- Medicare Current Beneficiary Survey (MCBS)
- Application and Triennial Re-application to Be a Qualified Entity to Receive Medicare Data for Performance Measurement
Comments are due by March 22, 2022.
Expedited Review Process for Hospital Inpatients in Original Medicare
On January 21, CMS published Medicare Claims Processing Transmittal 11210 regarding changes to the section in the Claims Processing Manual, which covers expedited determinations of inpatient hospital discharges, to improve readability and understanding. There are no substantive updates.
Effective date: April 21, 2022
Implementation date: April 21, 2022