This week in Medicare updates—1/8/2020
Burden Reduction and Discharge Planning Final Rules Guidance and Process
On December 20, CMS published a Memorandum to state survey agency directors regarding changes to the State Operations Manual to align guidance with policies finalized in a pair of 2019 final rules. These include the Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction final rule and the Revisions to Requirements for Discharge Planning for Hospitals, Critical Access Hospitals, and Home Health Agencies final rule. Changes affect a wide variety of provider types in many different settings, and thus should be reviewed by all providers.
Effective date: Immediately. This policy should be communicated with all survey and certification staff, their managers, and the state/regional office training coordinators within 30 days of this memorandum.
Updated Civil Monetary Penalties and Affirmative Exclusions
On December 23, the OIG published an updated List of Civil Monetary Penalties and Affirmative Exclusions, including the following:
- On November 22, Rockdale Medical Center, of Conyers, Georgia, reached a $70,000 settlement agreement with the OIG to resolve allegations that RMC violated EMTALA by failing to provide a medical screening exam, stabilizing treatment, or proper transfer for a patient who was brought by ambulance to the medical center. The medical center had told EMS prior to the ambulance’s arrival that the patient should be taken to a trauma center, but when the ambulance arrived at the medical center anyway, a hospital nurse met the ambulance in the ambulance bay and redirected the ambulance to the trauma center without examining the patient. The patient deteriorated during transport and subsequently died at the receiving hospital.
- On December 11, Enrico Fazzini, D.O., and Enrico Fazzini, D.O. Ph.D., P.C., of New York, reached a $191,209.96 settlement with the OIG to resolve allegations of reporting CPT code 95937 without performing NMJ testing and reporting CPT code 95913 despite performing fewer conduction studies than the CPT code requires.
- On December 12, American Toxicology Lab, LLC, of Johnson City, Tennessee, reached a $175,889.72 settlement with the OIG to resolve allegations that ATL submitted claims to Medicare for specimen validity testing, a non-covered service.
Comment Request: End Stage Renal Disease Network Semi-Annual Cost Report Forms and Supporting Regulations
On December 26, CMS published a Comment Request in the Federal Register regarding an information collection titled, “End Stage Renal Disease Network Semi-Annual Cost Report Forms and Supporting Regulations.” Comments are due by February 24, 2020.
Application from Accreditation Association of Hospitals/Health Systems--Healthcare Facilities Accreditation Program (AAHHS-HFAP) for Continued CMS Approval of its Critical Access Hospital (CAH) Accreditation Program
On December 26, CMS published a Final Notice in the Federal Register to announce it has approved the application from AAHHS-HFAP for continued recognition as a national accrediting organization for critical access hospitals wishing to participate in Medicare or Medicaid.
Dates: This final notice is effective December 27, 2019, through December 27, 2025.
New Medicare Provider Specialty Code (D5) and Billing Codes for Opioid Treatment Programs and New Place of Service Code 58
On December 27, CMS published Medicare Claims Processing Transmittal 4486 and Medicare Financial Management Transmittal 333, which rescinds and replaces Transmittal 4472 and Transmittal 332, respectively, each dated December 5, 2019, to replace Attachment A (G-Codes with Payment Adjusted by Locality) with a new spreadsheet. The original transmittals were issued regarding coding and payment rates for opioid treatment programs as well as enrollment information.
Effective date: January 1, 2020
Implementation date: January 6, 2020
Advanced Alternative Payment Model (APM) Incentive Payment Advisory for Clinicians--Request for Current Banking Information for Qualifying APM Participants
On December 30, CMS published a Payment Advisory in the Federal Register to alert clinicians participating in Qualifying APMs who are eligible to receive APM Incentive Payments that CMS needs them to update banking information to receive this payment, as CMS currently does not have the banking information necessary to make a payment.
Dates: This advisory is effective on December 30, 2019.
Announcement of the Advisory Panel on Outreach and Education (APOE); January 15, 2020 Meeting
On December 30, CMS published a Notice in the Federal Register to announce the next meeting of the APOE will take place on Wednesday, January 15, 2020 from 8:30 a.m. to 4:00 p.m. ET. The announcement also includes deadlines for presentations and special accommodations.
January 2020 Update of the Ambulatory Surgical Center (ASC) Payment System
On December 31, CMS published Medicare Claims Processing Transmittal 4485 regarding changes to and billing instructions for the January 2020 ASC Payment System update. These include five new device pass-through categories, a new separately payable procedure code for spine/lumbar disk surgery, new high/low cost assignments for skin substitutes, and more.
On January 2, CMS published MLN Matters 11607 to accompany the transmittal.
Effective date: January 1, 2020
Implementation date: January 6, 2020
Correction Notice: 2020 Medicare Physician Fee Schedule Final Rule
On January 2, CMS published a Correction Notice in the Federal Register regarding technical corrections for the 2020 Medicare Physician Fee Schedule final rule. These include adding in a previously missing applicability date for certain provisions in the payment for E/M services section of the rule, deleting a line about billing G0511 for PCM in a section about rural health clinics/federally qualified health centers, changes to table names, and more.
The correction document is effective January 1, 2020.
Continuation of and Extension of Timeline for Adjustment of Civil Monetary Penalties for Inflation Final Rule
On January 2, CMS published a Notice in the Federal Register regarding the continuation of the 2016 interim final rule on the adjustment of civil monetary penalties for inflation. CMS stated that it inadvertently missed setting a target date for the final rule, and it is therefore continuing this interim final rule to allow time to publish a final rule.
Dates: Effective December 31, 2019, Medicare provisions adopted in the interim final rule published on September 6, 2016, continue in effect and the regular timeline for publication of the final rule is extended for an additional year, until September 6, 2020.
IVIG Demonstration: Payment Update for 2020
On January 2, CMS published MLN Matters 11372 to supplement Demonstrations Transmittal 234, dated November 27, 2019, regarding the 2020 payment rate for the IVIG Demonstration, which is $374.20.
Effective date: January 1, 2020
Implementation date: January 6, 2020
Correction Notice: 2020 Hospital Outpatient Prospective Payment System Final Rule
On January 3, CMS published a Correction Notice in the Federal Register regarding corrections to technical errors in the 2020 OPPS final rule. These include changes to the standard wage index conversion factor budget neutrality adjustment from 0.9990 to 0.9991, a change to the wage index budget neutrality factor from 0.9981 to 0.9982, changes to typographical errors resulting in incorrect status indicators for certain CPT codes, and more.
Effective date: January 1, 2020
CY 2020 Update for DMEPOS Fee Schedule
On January 3, CMS published Medicare Claims Processing Transmittal 4487, which rescinds and replaces Transmittal 4470, dated December 6, 2019, to correct the CY 2020 maintenance and servicing fee for certain oxygen equipment to $73.02 in BR 11570.9. The original transmittal was issued regarding the implementation of the 2020 updates to the DMEPOS fee schedule. This includes new codes, payment updates, changes to payment for therapeutic shoes and diabetic testing supplies, and more.
On January 3, CMS revised MLN Matters 11570 to accompany the transmittal.
Effective date: January 1, 2020
Implementation date: January 6, 2020
Comment Period Extension: Transparency in Coverage Proposed Rule
On January 3, HHS published an Extension Notice in the Federal Register to extend the comment period for the Transparency in Coverage proposed rule, dated November 27, 2019. The comment period was originally scheduled to close on January 14, 2020, but due to considerable interest and requests from stakeholders to have additional time to review and submit comments, CMS is extending this comment period until January 29, 2020.
New State Codes for California, Kentucky, and West Virginia
On January 3, CMS published One-Time Notification Transmittal 2413 regarding new state codes for California, Kentucky, and West Virginia. These states have exhausted their supply of CMS certification numbers for multiple provider types, so these codes are in addition to the state codes they already possess.
Effective date: April 1, 2020
Implementation date: April 6, 2020