This week in Medicare updates—3/14/18
National Coverage Analysis (NCA) for Next Generation Sequencing (NGS) for Medicare Beneficiaries with Advanced Cancer
On March 6, CMS updated the Tracking Sheet to extend the comment period for an NCA on NGS for Medicare beneficiaries with advanced cancer. The original comment period ran from December 18, 2017, through January 17, 2018. CMS extended this comment period due to the high volume of public comments
Average Sales Price (ASP) Drug Pricing Files April 2018 Update
On March 6, CMS posted Downloadable Files to the 2018 Drug Pricing Files webpage containing the April 2018 ASP and Not Otherwise Classified (NOC) pricing files and crosswalks. These files contain the payment amounts that will be used to pay for Part B covered drugs for the second quarter of 2018.
Trump Administration Announces MyHealthEData Initiative at HIMSS18
On March 6, CMS issued a Fact Sheet and a Press Release regarding a new healthcare data initiative called MyHealthEData, which aims to ensure patients will have access to their full healthcare records and can take that data with them from doctor to doctor and provider to provider. As part of this initiative, CMS announced it will launch Medicare Blue Button 2.0 to provide beneficiaries with claims data in a universal and secure digital format. Blue Button 2.0 will contain four years of Medicare Part A, B, and D data. CMS has also recruited more than 100 organizations to join the Blue Button 2.0 developer preview program to help build applications that would enable beneficiaries to give physicians access to information on a given beneficiary’s current prescriptions and medical history.
Reliance on Unverified Patient Lists Creates a Vulnerability in Home Health Surveys
On March 8, the OIG published a Review of home health agencies (HHAs) and their patient lists. The OIG conducted the review to determine whether HHAs manipulate patient lists given to surveyors for review as a way to avoid scrutiny of certain patients. The OIG found that some HHA-supplied patient lists were missing Medicare beneficiaries, which would allow them to be excluded from surveyor reviews. The OIG also found that surveyors cannot verify that an HHA-supplied patient list is complete at the time surveyors conduct their surveys. Therefore, the OIG recommends CMS explore the costs and benefits of pursuing potential strategies specified within the review to limit the vulnerabilities and risk of fraudulent activity involved in patient lists.
Inpatient Rehabilitation Facility (IRF) and Long-Term Care Hospital (LTCH) Compare Refresh
On March 8, CMS published a Notice in MLN Connects to announce that the March 2018 quarterly IRF and LTCH Compare refresh is available on the respective IRF and LTCH websites. The update includes quality measure results based on data submitted to CMS between the second quarter of 2016 and the first quarter of 2017.
Correction to Pub. 100-04, Chapter 5
On March 9, CMS published Medicare Claims Processing Transmittal 3995 to update the Medicare Claims Processing Manual in order to accurately reflect the list of Types of Bill subject to the current Medicare policies for therapy caps and related policies in the critical access hospital setting.
Effective date: June 11, 2018
Implementation date: June 11, 2018
April Quarterly Update for 2018 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule
On March 9, CMS published Medicare Claims Processing Transmittal 3994 regarding the April quarterly update to the DMEPOS fee schedule. One of the April updates includes a revision to modifier -QF (Prescribed amount of stationary oxygen while at rest exceeds 4 liters per minute and portable oxygen is prescribed) and the addition of new oxygen volume adjustment modifier -QB (Prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts exceeds 4 liters per minute and portable oxygen is prescribed).
Effective date: April 1, 2018
Implementation date: April 2, 2018
April 2018 Update of the Ambulatory Surgical Center (ASC) Payment System
On March 9, CMS published Medicare Claims Processing Transmittal 3996 regarding the April 2018 changes to and billing instructions for various payment policies in the ASC. Some of these updates include new HCPCS codes for reporting drugs and biologicals, a new separately payable HCPCS code for repair of nasal stenosis, and changes to three biosimilar biological product HCPCS codes.
Effective date: April 1, 2018
Implementation date: April 2, 2018