This week in Medicare updates—2/13/19

February 13, 2019
Medicare Insider

Medicare Provider-Supplier Enrollment National Education Products

On February 4, CMS published an Index of different sources providing information on Medicare provider-supplier enrollment topics. The index contains resources for multiple types of providers as well as resources related to the PECOS system.

 

Updated List of Excluded Individuals and Entities (LEIE)

On February 5, the OIG updated its LEIE with an updated LEIE database for download and lists of January 2018 exclusions, reinstatements, and profile corrections.

 

New App Displays What Original Medicare Covers

On February 6, CMS published a Press Release regarding a new app that will allow beneficiaries, caregivers, and others to check Medicare coverage for an item or service. This app, called the “What’s Covered” app, is part of the eMedicare initiative and is designed to give consumers more access and control over their Medicare information.

 

Updated Corporate Integrity Agreement Documents

On February 6, the OIG published information on one new and three closed Corporate Integrity Agreements, including:

  • A new agreement with Greenway Health, LLC, of Tampa, FL
  • A closed agreement with Hospice of the Comforter, Inc., of Alamonte Springs, FL
  • A closed agreement with Filyn Corporation d/b/a Lynch Ambulance, of Anaheim, CA
  • A closed agreement with Michie Medical Clinic, Rhoads, Mary Sue, of Michie, TN

 

Updated Provider Self-Disclosure Settlements

On February 7, the OIG published an updated List of Provider Self-Disclosure Settlements, including:

  • On January 9, Fort Bend County, of Texas, reached a $4,526,740.26 settlement with the OIG to resolve allegations that it submitted claims for ambulance transportation services that did not have the necessary beneficiary authorization for ambulance transports
  • On January 23, Personalized Therapy, LLC, of Maryland, reached a $334,519.37 settlement with the OIG to resolve allegations that it improperly billed Tricare for services provided by an occupational therapist assistant when those services were not reimbursable

The list also includes multiple settlements due to facilities employing individuals they knew or should have known were excluded from participation in federal health care programs, including:

  • Valley’s Best Hospice, of California
  • PHI Air Medical, LLC, of Arizona
  • IHC Health Services, Inc., d/b/a Intermountain Medical Center, of Utah

 

Updated Stipulated Penalties and Exclusion for Material Breach

On February 7, the OIG updated its list of Stipulated Penalties and Exclusion for Material Breaches with one new action:

  • On February 4, 2019, Cornerstone Healthcare Services, LLC, paid a stipulated penalty of $22,500 for failing to pay two invoices received from the Quality Monitor

 

Updated Civil Monetary Penalties and Affirmative Exclusions

On February 7, the OIG published an updated List of Civil Monetary Penalties and Affirmative Exclusions agreements, including:

  • On January 24, Northern Kentucky Center for Pain Relief, LLC, of Florence, Kentucky, reached a $126,799.90 settlement with the OIG to resolve allegations that it submitted claims for specimen validity testing, a non-covered service.

 

Update to the Internet Only Manual (IOM) Publication (Pub.) 100-04, Chapter 32, Section 12.1

On February 8, CMS published Medicare Claims Processing Transmittal 4237 regarding changes to the manual to remove incorrectly listed diagnosis codes for Counseling to Prevent Tobacco Use. The transmittal also adds a handful of new diagnosis codes into this section of the manual.

Effective date: March 12, 2019

Implementation date: March 12, 2019

 

Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - April 2019 Update

On February 8, CMS published Medicare Claims Processing Transmittal 4234 regarding amendments to payment files based upon the CY 2019 MPFS final rule.

Effective date: January 1, 2019

Implementation date: April 1, 2019

 

Updates to Manuals to Provide Language-Only Changes for the New Medicare Project

On February 8, CMS published multiple transmittals to update language in various manuals regarding the new Medicare cards. These updates include

Effective date: March 12, 2019

Implementation date: March 12, 2019

 

Update to Chapter 15 of Publication (Pub.) 100-08

On February 8, CMS published Medicare Program Integrity Transmittal 862 regarding several changes to provider enrollment policies. As part of these changes, CMS is adding information about Medicare’s Part C and D Preclusion List and provider rights to appeal placement on the preclusion list.

Effective date: March 12, 2019

Implementation date: March 12, 2019

 

Implementation of the Skilled Nursing Facility (SNF) Patient-Driven Payment Model (PDPM)

On February 8, CMS published One-Time Notification Transmittal 2252 regarding the implementation of PDPM. These policies will apply to SNFs billing on Type of Bill (TOB) 21X and hospital swing bed providers billing on TOB 18X. The PDPM implementation will include changes to Health Insurance Prospective Payment System (HIPPS) Rate Codes, the PPS assessment schedule, adjustment factors for AIDS/HIV patients, and a new interrupted stay policy.

CMS published MLN Matters 11152 on the same date to accompany the transmittal.

Effective date: October 1, 2019

Implementation date: July 1, 2019 - SWF Implementation in July; July 1, 2019 - CWF and FISS Coding and Testing in July 2019; October 1, 2019 - Pricer updates and continue testing

 

Implementation of Additional Contact with Providers in the Event of a Rejected Cost Report Filing

On February 8, CMS published One-Time Notification Transmittal 2253 regarding instructions for MACs to initiate additional contact with providers in the event that a provider’s cost report is rejected. This policy is intended to avoid unnecessary payment suspension for items that cause cost reports to be rejected but can be easily corrected by the provider.

Effective date: March 12, 2019

Implementation date: March 12, 2019