This week in Medicare updates—3/21/18

March 21, 2018
Medicare Insider

Quarterly Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge Payment

On March 14, CMS issued Medicare Claims Processing Transmittal 3999, which rescinds and replaces Transmittal 3973, dated February 8, 2018, to remove the list of new HCPCS codes that were effective as of April 1, 2018 with a -QW modifier from the policy section. The original transmittal was issued to provide instructions for the quarterly update to the CLFS.

On March 15, CMS issued a revised version of MLN Matters 10445 to accompany the transmittal.

Effective date: January 1, 2018 - For new HCPCS codes listed in the Background section; April 1, 2018

Implementation date: April 2, 2018  


MLN Booklet: Home Health Prospective Payment System (HH PPS)

On March 15, CMS published a Booklet to educate providers on the HH PPS, consolidated billing requirements, home health qualification criteria, requirements for therapy service eligibility, and changes to the HH PPS for the 2018 calendar year.     


Update to OIG Work Plan

On March 15, the OIG updated its Work Plan to include the following reviews:


Hospitals Did Not Comply With Medicare Requirements for Reporting Certain Cardiac Device Credits

On March 15, the OIG published a Review of whether hospitals complied with Medicare requirements for reporting manufacturing credits associated with five recalled or prematurely failed cardiac devices. The OIG found that all 296 payments reviewed did not comply with Medicare requirements for reporting manufacturer credits, resulting in $4.4 million in potential overpayments. The OIG said many of these claims were not compliant because they did not contain proper condition codes, value codes, or modifiers to reduce payments as required. Medicare controls were not sufficient to ensure that hospitals properly reported these credits for cardiac devices.

The OIG recommends CMS instruct MACs to notify the 210 hospitals associated with the 296 claims with potential overpayments so those hospitals can return any identified overpayments in accordance with the 60-day rule. The OIG also recommends CMS educate providers on requirements for reporting manufacturer credits, instruct Medicare contractors to implement a post-payment process to help determine whether an adjustment claim should be submitted for cardiac device replacement procedures, and consider alternatives to implementing edits in order to eliminate the current Medicare requirements for reporting device credits.


Special Edition MLN Matters: Billing Requirements for OPPS Providers with Multiple Service Locations

On March 15, CMS published Special Edition MLN Matters 18002 to review of billing requirements discussed in previous transmittals and to assist OPPS providers who have multiple service locations submitting claims to MACs. The article includes instructions on providing claim level information and line level information. It also includes a table instructing providers on which modifiers facilities should use for specific types of locations.

Effective date: January 1, 2017

Implementation date: January 3, 2017 for CR9613 and July 3, 2017 for CR9907


National Correct Coding Initiative (NCCI) Add-on Codes for Non-Outpatient Prospective Payment System (OPPS) Institutional Providers Implementation

On March 16, CMS published One-Time Notification Transmittal 2044 to implement NCCI add-on code edits for non-OPPS institutional providers. The transmittal also contains instructions for MACs on how to identify add-on codes and how to distinguish between payment policies for different types of add-on codes.

Effective date: April 1, 2018

Implementation date: April 2, 2018


The Supplemental Security Income (SSI)/Medicare Beneficiary Data for Fiscal Year 2016 for Inpatient Prospective Payment System (IPPS) Hospitals, Inpatient Rehabilitation Facilities (IRFs), and Long Term Care Hospitals (LTCH)

On March 16, CMS published One-Time Notification Transmittal 2043 to provide updated data to determine the disproportionate share adjustment for IPPS hospitals and the low-income patient adjustment for IRFs. The transmittal also provides updated data for payments as applicable for LTCH discharges. This data is used for cost reporting periods beginning in and during fiscal year 2016 except when explicitly directed otherwise by CMS.

CMS published MLN Matters 10527 on the same date to accompany the transmittal.

Effective date: April 16, 2018

Implementation date: April 16, 2018


Provider Cost Reporting Forms and Instructions, Chapter 40, Form CMS-2552-10

On March 16, CMS published Medicare Provider Reimbursement Manual Transmittal 14 regarding updates to Chapter 40 (Hospital and Hospital Health Care Complex Cost Report) of the manual to include accommodations for select provisions of the Bipartisan Budget Act of 2018, the 2018 Inpatient Prospective Payment System final rule, and the 2018 Long Term Care Hospital final rule. The transmittal also contains numerous revisions for cost reporting worksheets.

Revised electronic specifications effective date: Changes to the electronic reporting specifications are effective for cost reporting periods ending on or after January 31, 2018.


Internet Only Manual Update to Pub 100-04, Chapter 16, Section 40.8 - Date of Service Policy

On March 16, CMS published Medicare Claims Processing Transmittal 4000 regarding changes to the manual pursuant to the new date of service (DOS) policy for molecular pathology laboratory tests and advanced diagnostic laboratory tests as established by the 2018 OPPS final rule. These changes apply to Chapter 16, Section 40.8 of the manual.

Effective date: January 1, 2018

Implementation date: July 2, 2018


Final Decision Memo for Next Generation Sequencing (NGS) for Medicare Beneficiaries with Advanced Cancer

On March 16, CMS posted a Final Decision Memo regarding revisions to an NCD on NGS for Medicare beneficiaries with advanced cancer. CMS has finalized coverage of these diagnostic laboratory tests to help detect genetic mutations, which will assist patients and providers in making more informed treatment decisions. Coverage will include patients with recurrent, metastatic, relapsed, refractory, or stages III or IV cancer.

CMS issued a Press Release regarding the finalized NCD on the same date.