This week in Medicare updates—1/29/2020
Skilled Nursing Facility Prospective Payment System
On January 21, CMS published an MLN Booklet on the Skilled Nursing Facility (SNF) Prospective Payment System. The booklet details the way payment rates are calculated and discusses the Patient-Driven Payment Model (PDPM), MDS changes, consolidated billing, and more. It also contains a number of helpful tables with resources for providers on billing for SNF services.
Decision Memo for Acupuncture for Chronic Low Back Pain
On January 21, CMS published a Final Decision Memo regarding coverage for acupuncture for chronic low back pain. CMS will cover up to 12 visits of acupuncture within 90 days for chronic low back pain, and it will cover an additional eight sessions for patients demonstrating an improvement. Coverage is limited to 20 acupuncture treatments per year. The NCD also specifies permissible provider types for this treatment.
CMS published a Press Release on the decision memo on the same date.
Increasing Access to Innovative Antibiotics for Hospital Inpatients Using New Technology Add-On Payments: Frequently Asked Questions
On January 21, CMS published Special Edition MLN Matters 20004 regarding changes to new technology add-on payments (NTAP) under the IPPS that are meant to increase access to innovative antibiotics for hospital inpatients. The article contains Q&As on these changes, how hospitals should bill for NTAP, special billing requirements, how payments will work, and more.
Updated Civil Monetary Penalties and Affirmative Exclusions
On January 22, the OIG published an updated List of Civil Monetary Penalties and Affirmative Exclusions, including:
- On December 16, Florida Hospital Heartland Medical Center, of Sebring, Florida, reached a $35,000 settlement agreement with the OIG to resolve allegations that it violated EMTALA by failing to provide an adequate medical screening examination and stabilizing treatment for a nearly 18-year-old patient, who was instructed to follow up with a pediatric urologist rather than being seen or evaluated by the on-call urologist.
- On December 26, San Mateo Medical Center, of San Mateo, California, reached a $20,000 settlement agreement with the OIG to resolve allegations that it violated EMTALA by failing to provide a vaginal exam to a 25-week pregnant patient. The hospital did not determine whether the patient was in labor and arranged for the patient to be transferred to a different hospital but recommended the patient take her own vehicle as ambulance transport would result in a 45-minute wait. The patient self-delivered the baby in the car on the way to the other hospital, and the baby was not able to be resuscitated.
- On December 26, St. Rose Dominican Hospital - Siena Campus, of Henderson, Nevada, reached a $90,000 settlement agreement with the OIG to resolve allegations that it violated EMTALA by failing to provide an appropriate exam, treatment, and transfer of a patient who presented with dizziness, black stool, yellow skin, and stiff muscles. The patient was transferred with low blood pressure but did not receive any blood products. He went into cardiac arrest and died at the receiving hospital.
- On December 26, Lynne S. Brodell, DDS, of Cumberland, Maryland, reached a $94,096.64 settlement agreement with the OIG to resolve allegations that she employed an individual who was excluded from participating in any federal health care programs and billed federal health care programs for services provided by this employee.
CY 2020 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment
On January 22, CMS published Medicare Claims Processing Transmittal 4498, which rescinds and replaces Transmittal 4476, dated December 13, 2019, to revise the policy section. The original transmittal was published regarding the updates to the clinical laboratory fee schedule, mapping for new codes for clinical lab tests, data reporting periods for applicable labs, and updates for lab costs subject to the reasonable charge payment.
On January 23, CMS revised MLN Matters 11598 to accompany the transmittal.
Effective date: January 1, 2020
Implementation date: January 6, 2020
Add Dates of Service for Pneumococcal Pneumonia Vaccination (PPV) HCPCS Codes (90670, 90732) and Remove Next Eligible Dates for PPV HCPCS
On January 22, CMS published One-Time Notification Transmittal 2422, which rescinds and replaces Transmittal 2408, dated December 12, 2019, to revise business requirements 11335.3 and 11335.5 removing the reference to the HIQA/HIQH and ELGA/ELGH screens. The original transmittal was issued regarding a process that will allow the CWF to send the date of service for PPV HCPCS codes 90670 and 90732 in separate records to the Medicare Beneficiary Database so that a provider can determine whether a beneficiary has had a first dose or second dose of a vaccination.
CMS revised MLN Matters 11335 on January 23 to accompany the transmittal.
Effective date: April 1, 2020 - For all requirements except 11335.8; July 1, 2020 - For requirement 11335.8
Implementation date: April 6, 2020 - For all requirements except 11335.8; July 6, 2020 - For requirement 11335.8
Updated Corporate Integrity Agreement Documents
On January 23, the OIG published information on new Corporate Integrity Agreements with:
- Southeastern Retina Associates, P.C., of Knoxville, TN
- Patient Services, Inc., of Midlothian, VA
Update to ICD-10-CM for Vaping Related Disorder
On January 24, CMS published Medicare Claims Processing Transmittal 4499 regarding a new ICD-10-CM code for vaping related disorder. The code will be added to the MS-DRG Grouper and MCE software effective for discharges on and after April 1, 2020.
CMS published MLN Matters 11623 on the same date to accompany the transmittal.
Effective date: April 1, 2020
Implementation date: April 6, 2020