This week in Medicare updates—2/19/2020
Life Safety and Emergency Preparedness Deficiencies Found at 18 of 20 Texas Nursing Homes
On February 10, the OIG published a Review of whether nursing homes in Texas who received funds from Medicare, Medicaid, or both who were also located close to the Gulf of Mexico (an area with a high number of previously identified deficiencies) complied with requirements for life safety and emergency preparedness. The OIG found deficiencies at 18 of the 20 nursing homes reviewed related to a variety of life safety deficiencies (e.g., fire drills, hazardous storage areas, etc.) and emergency preparedness deficiencies (e.g., emergency supplies and power, emergency communication plans, etc.). The OIG concluded that these deficiencies occurred due to inadequate management oversight as well as frequent staff turnover and buildings that were advanced in age.
The OIG recommends Texas follow up with the 18 deficient nursing homes to verify corrective actions have been taken regarding the identified life safety and emergency preparedness deficiencies. Texas concurred with this recommendation and noted it had developed training courses for maintenance and emergency preparedness that were held as recently as December 2019 and will continue to be provided throughout 2020.
The Role of Therapy under the Home Health Patient-Driven Groupings Model (PDGM)
On February 10, CMS published Special Edition MLN Matters 20005 regarding therapy services furnished at home health agencies under a physician-established Medicare home health plan of care. The article discusses the role of therapy under PDGM and notes that while payments are now bundled into 30-day payment units, the need for and provision of therapy services under the home health benefit should remain unchanged.
Effective date: January 1, 2020
Implementation date: January 1, 2020
Update to the Required Prior Authorization List of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items that Require Prior Authorization as a Condition of Payment
On February 11, CMS published an Updated List in the Federal Register of the continuation of prior authorization of 45 HCPCS codes for DMEPOS items that require prior authorization as a condition of payment. It also added six new HCPCS codes to the list. Prior authorization for these additional codes will be implemented in two phases.
Dates: Phase one of implementation is effective May 11, 2020. Phase two of implementation is effective October 8, 2020.
CMS Develops New Code for Coronavirus Lab Test
On February 13, CMS published a Press Release regarding a new HCPCS code for testing for coronavirus. Beginning on April 1, the Medicare claims processing system will accept HCPCS code U0001 when used to report the CDC 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel for dates of service on or after February 4, 2020.
Quarterly Listing of Program Issuances--October through December 2019
On February 13, CMS published a Notice in the Federal Register to announce the quarterly list of all program issuances published from October through December 2019 relating to the Medicare and Medicaid programs.
January 2020 Integrated Outpatient Code Editor (I/OCE) Specifications Version 21.0
On February 13, CMS published Medicare Claims Processing Transmittal 4528, which rescinds and replaces Transmittal 4483, dated December 20, 2019, to add two new attachments due to legislation. The original transmittal was issued regarding the January 2020 quarterly update of the I/OCE. This includes changes to APCs, HCPCS codes, device additions, and more.
CMS revised MLN Matters 11564 on the same date to accompany the transmittal.
Effective date: January 1, 2020
Implementation date: January 6, 2020
Proposed Rule: Medicare Secondary Payer and Certain Civil Monetary Penalties
On February 14, CMS published a draft copy of a Proposed Rule regarding how and when CMS must take action via civil monetary penalties when group health plan and non-group health plans fail to meet Medicare Secondary Payer reporting obligations in certain ways. This includes instances when responsible reporting entities fail to register and report as required, report in a manner that exceeds error tolerances established by HHS, or contradict information they have reported when CMS attempts to recover payments from the responsible reporting entities.
CMS published a Fact Sheet on the rule on the same date. Comments are due 60 days after the rule’s publication in the Federal Register, which is scheduled for February 18.
The Majority of Providers Reviewed Used Medicare Part D Eligibility Verification Transactions for Potentially Inappropriate Purposes
On February 14, the OIG published a Review of whether providers used eligibility verification transactions (E1 transactions) to bill for a prescription or determine drug coverage billing orders. The OIG found that 25 of the 30 providers reviewed were using these transactions for something other than to bill for a prescription or determine drug coverage billing orders, and 98% of those transactions were not associated with a prescription. This is an inappropriate use of E1 transactions, which is especially perilous given that these transactions contain protected health information. The deficiencies occurred because CMS had not yet implemented controls to monitor providers submitting a high number of E1 transactions compared to the prescriptions processed, CMS did not have clear guidance that E1 transactions are not to be used for marketing purposes, and CMS had not yet limited non-pharmacy access.
The OIG recommends CMS monitor providers submitting a high number of E1 transactions relative to prescriptions processed, issue guidance not to use these transactions for marketing purposes, ensure only pharmacies and other authorized entities submit these transactions, and take appropriate enforcement action when abuse is identified.
Changes to Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems, Correcting Amendment
On February 14, CMS published a Correcting Amendment in the Federal Register regarding a technical error from the final rule document published on November 12, 2019 which resulted in the inadvertent removal of certain paragraphs from the rule. The correcting amendment adds paragraphs back into the rule.
Dates: This correcting amendment is effective February 14, 2020 and is applicable beginning January 1, 2020.
Comment Request: Generic Clearance for Improving Customer Experience
On February 14, CMS published a Comment Request in the Federal Register regarding an information collection titled, “Generic Clearance for Improving Customer Experience (OMB Circular A-11, Section 280 Implementation).” Comments are due by April 14, 2020.
User CR: ViPS Medicare System (VMS) Report Daily Edit Receipts
On February 14, CMS published One-Time Notification Transmittal 2437 regarding a new report for DME MACs that will capture daily receipt of edits instead of an accumulation of edits. The existing SC0011 report will be made obsolete with the implementation of this change.
Effective date: July 1, 2020
Implementation date: July 6, 2020
Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - April 2020 Update
On February 14, CMS published Medicare Claims Processing Transmittal 4525 regarding an update to payment files for the Medicare Physician Fee Schedule.
Effective date: January 1, 2020
Implementation date: April 6, 2020
Implementation of the Long Term Care Hospital (LTCH) Discharge Payment Percentage (DPP) Payment Adjustment
On February 14, CMS published Medicare Claims Processing Transmittal 4529 regarding preparations for the Medicare claims processing systems to calculate the LTCH PPS payment when an LTCH is subject to the discharge payment percentage payment adjustment.
Effective date: Cost reporting periods beginning on or after October 1, 2019
Implementation date: July 6, 2020
Update to Medicare Benefit Policy Manual and Medicare Claims Processing Manual Adding New Chapters for Opioid Treatment Programs (Manual Updates Only)
On February 14, CMS published Medicare Benefit Policy Transmittal 268 and Medicare Claims Processing Transmittal 4524 regarding updates to the manuals to add new chapters to each that are devoted to opioid treatment programs.
Effective date: January 1, 2020
Implementation date: March 16, 2020