This week in Medicare updates—3/20/19
Specialized Infection Prevention and Control Training for Nursing Home Staff in the Long-Term Care Setting is Now Available
On March 11, CMS published a Memorandum to state survey agency directors regarding a new online training course in infection prevention and control for nursing home staff in the long-term care setting. The training provides approximately 19 hours of continuing education credits and is available for free on the CDC’s TRAIN website. The memo supersedes memo Quality, Safety & Oversight policy memorandum QSO 18-15-NH.
CMS published a Fact Sheet regarding the course on the same date.
Effective date: This information 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 Corporate Integrity Agreement Documents
On March 11, the OIG published information on a new Corporate Integrity Agreement with Skyline Urology, of Torrance, CA.
Updated List of Excluded Individuals and Entities (LEIE)
On March 11, the OIG updated its LEIE with an updated LEIE database for download and lists of February 2019 exclusions, reinstatements, and profile corrections.
Comment Request: Recognition of Pass-Through Payment for Additional (New) Categories of Devices under the Outpatient Prospective Payment System and Supporting Regulations; Waiver Application for Providers and Suppliers Subject to an Enrollment Moratorium
On March 12, CMS published a Comment Request in the Federal Register regarding the following information collections:
- Recognition of Pass-Through Payment for Additional (New) Categories of Devices under the Outpatient Prospective Payment System and Supporting Regulations
- Waiver Application for Providers and Suppliers Subject to an Enrollment Moratorium
Comments on the information collections are due by May 13, 2019.
Implementation of the Skilled Nursing Facility (SNF) Patient-Driven Payment Model (PDPM)
On March 13, CMS published One-Time Notification Transmittal 2270, which rescinds and replaces Transmittal 2252, published February 8, 2019, to remove business requirements 11152.2 and 11152.3 and to revise business requirement 11152.4.3. The original transmittal was issued regarding the implementation of PDPM.
CMS revised MLN Matters 11152 on March 14 to accompany the transmittal.
Effective date: October 1, 2019
Implementation date: July 1, 2019 - CWF and FISS Coding and Testing in July 2019; July 1, 2019 - CWF Implementation in July; October 1, 2019 - Pricer updates and continue testing
Ensuring Only the Active Billing Hospice Can Submit a Revocation
On March 13, CMS published Medicare Claims Processing Transmittal 4254, which rescinds and replaces Transmittal 4187, dated December 28, 2018, to add FISS responsibility to BR 11049.1.1 and to clarify the first bullet of BR 11049.1. The original transmittal was issued regarding a new Common Working File edit to ensure that the provider identifier on Type of Bill (8xB) matches the most recent provider identifier on a hospice benefit period.
On March 14, CMS published a revised MLN Matters 11049 to accompany the transmittal.
Effective date: July 1, 2019 - Claims received on or after this date
Implementation date: July 1, 2019
Implementation of the Medicare Performance Adjustment (MPA) for the Maryland Total Cost of Care (MD TCOC) Model
On March 14, CMS published Medicare Claims Processing Transmittal 4257, which rescinds and replaces Transmittal 4230, dated February 1, 2019, to update elements of the Provider Specific File in chapters three and four of the Claims Processing Manual. The original transmittal was issued regarding the implementation of adjusted payment amounts for hospital claims in Maryland as part of the MD TCOC Model.
Effective date: July 1, 2019
Implementation date: July 1, 2019 - Coding and Implementation
CMS Updates Drug Dashboards with Prescription Drug Pricing and Spending Data
On March 14, CMS published a Press Release regarding updates to the Drug Spending Dashboards with data for 2017. In 2017, total gross spending on prescription drugs was $154.9 billion in Medicare Part D and $30.4 billion in Part B.
Correction: Medicare Physician Fee Schedule Final Rule
On March 15, CMS published a Correction to the Medicare Physician Fee Schedule Final Rule in the Federal Register to correct technical errors in the evaluation and management services provisions that appeared in the rule as published November 23, 2018. The changes include corrections to headings, RVUs associated with modifier -53, information regarding who can furnish services for CPT code 99457, and references to certain sections of the final rule.
Effective date: March 14, 2019
Comment Request: Programs of All-Inclusive Care for the Elderly (PACE) 2020 Audit Protocol; Site Investigation for Suppliers of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS); more
On March 15, CMS published a Comment Request in the Federal Register regarding the following information collections:
- Programs of All-Inclusive Care for the Elderly (PACE) 2020 Audit Protocol
- Site Investigation for Suppliers of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)
- State Agency Sheets for Verifying Exclusions from the Inpatient Prospective Payment System and Supporting Regulations Rehabilitation Unit/Rehabilitation Hospital Criteria Worksheets
Comments on the information collections are due by May 14, 2019.
Comment Request: National Implementation of the Hospital CAHPS Survey; Home and Community Based Services (HCBS) Incident Management Survey; more
On March 15, CMS published a Comment Request in the Federal Register regarding the submission of the following information collections for OMB review:
- National Implementation of the Hospital CAHPS Survey
- Home and Community Based Services (HCBS) Incident Management Survey
- The State Flexibility to Stabilize the Market Grant Program Reporting
Comments on the information collections are due to the OMB desk officer by April 15, 2019.
Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print Update
On March 15, CMS published Medicare Claims Processing Transmittal 4253 regarding an update to the RARC and CARC lists and updates to the MREP and PC Print. These updates are based on the code update schedule that occurs three times per year.
CMS published MLN Matters 11204 on the same date to accompany the transmittal.
Effective date: July 1, 2019
Implementation date: July 1, 2019
April 2019 Update of the Hospital Outpatient Prospective Payment System (OPPS)
On March 15, CMS published Medicare Claims Processing Transmittal 4255 regarding April 2019 updates to various payment policies related to the OPPS. These updates include proprietary lab analyses CPT coding changes, a new advanced diagnostic laboratory test under the clinical lab fee schedule, new processes related to CAR T-Cell Therapy billing, and more.
Effective date: April 1, 2019
Implementation date: April 1, 2019
Updated OIG Work Plan
On March 15, the OIG updated its Work Plan with the following new items:
- Medicare Part B Drug Payments: Impact of Price Substitutions Based on 2017 Average Sales Prices
- Opioid Use in Medicare Part D in States in the Appalachian Region
- Post-Hospital Skilled Nursing Facility Care Provided to Dually Eligible Beneficiaries
- Fiscal Year 2018 Performance Data for the Senior Medicare Patrol Projects
- Medicare Market Shares of Mail Order Diabetes Test Strips
- Audit of FY 2019 CMS Financial Statements
- Review of Medicare Administrative Contractor Information Security Program Evaluations for FY 2018 (MMA 912)