This week in Medicare updates—3/27/2019
Approval of an Application from the Accreditation Association for Hospitals and Health Systems/Healthcare Facilities Accreditation Program for Continued CMS Approval of its Hospital Accreditation Program
On March 18, CMS published a Final Notice in the Federal Register to announce its decision to approve the Accreditation Association for Hospitals and Health Systems/Healthcare Facilities Accreditation Program (AAHHS/HFAP) for continued recognition as a national accrediting organization for hospitals.
Effective dates: This final notice is effective September 25, 2019, through September 25, 2023.
Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - April 2019 Update
On March 18, CMS published Medicare Claims Processing Transmittal 4258, which rescinds and replaces Transmittal 4234, dated February 8, 2019, to revise the attachment for codes G2014 and G2015. The original transmittal was issued regarding amendments to payment files based upon the CY 2019 MPFS final rule.
On March 18, CMS published a revised MLN Matters 11163 to accompany the transmittal.
Effective date: January 1, 2019
Implementation date: April 1, 2019
Updated Stipulated Penalties and Exclusion for Material Breach
On March 19, the OIG updated its list of Stipulated Penalties and Exclusion for Material Breaches with one new action:
- On March 12, Sorkin’s Rx Ltd. t/a and/or d/b/a CareMed Pharmaceutical Services paid a stipulated penalty of $12,500 due to the late submission of their claims review report that was due with their third annual report
Changes to the Laboratory National Coverage Determination (NCD) Edit Software for July 2019
On March 22, CMS published Medicare Claims Processing Transmittal 4265 to announce changes to the system for the July 2019 quarterly release of the edit module for clinical diagnostic laboratory services. The module will add ICD-10-CM code E11.10 effective 10/1/2017 to the list of ICD-10-CM codes covered by Medicare for the Thyroid Testing NCD (190.22).
Effective date: July 1, 2019
Implementation date: July 1, 2019
July 2019 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
On March 22, CMS published Medicare Claims Processing Transmittal 4264 regarding the quarterly release of the ASP and not otherwise classified drug pricing files for Medicare Part B drugs.
Effective date: July 1, 2019
Implementation date: July 1, 2019
April 2019 Update of the Ambulatory Surgical Center (ASC) Payment System
On March 22, CMS published Medicare Claims Processing Transmittal 4263 regarding changes to and billing instructions for various payment policies implemented in the April 2019 ASC payment system update. The updates include seven new HCPCS codes for drugs and biologicals in the ASC payment system, one new separately payable HCPCS code, reassignment of skin substitute products from the low cost group to the high cost group, and more.
Effective date: April 1, 2019
Implementation date: April 1, 2019
Billing for Hospital Part B Inpatient Services
On March 22, CMS published Medicare Claims Processing Transmittal 4259 regarding billing instructions for hospital Part B inpatient services. It includes instructions noting that hospitals may be paid for Part B inpatient services if it is determined under utilization review requirements that a beneficiary should have received hospital outpatient rather than hospital inpatient services and the beneficiary has already been discharged from the hospital. It also goes through the procedures involved in billing these scenarios.
Effective date: October 1, 2013
Implementation date: June 21, 2019
Update to Payment for Grandfathered Tribal Federally Qualified Health Centers (FQHCs) for Calendar Year 2019
On March 22, CMS published Medicare Claims Processing Transmittal 4261 to update the FQHC Prospective Payment System grandfathered tribal FQHC base payment rate. This rate is $405 for CY 2019.
Effective date: July 1, 2019
Implementation date: July 1, 2019
Manual Updates Related to Home Health Certification and Recertification Policy Changes
On March 22, CMS published Medicare Benefit Policy Transmittal 258 and Medicare Program Integrity Transmittal 870 regarding changes to the manual to reflect policies finalized in the CY 2019 Home Health Prospective Payment System final rule. These involve the elimination of the requirement that the certifying physician must estimate how much longer skilled care will be required when recertifying the patient for home health care. It also includes changes requiring the plan of care to include the identification of the responsible discipline(s) and frequency and duration of all visits.
Effective date: April 22, 2019
Implementation date: April 22, 2019