This week in Medicare updates—4/18/18
Transition to Payroll-Based Journal (PBJ) Staffing Measures on the Nursing Home Compare tool on Medicare.gov and the Five Star Quality Rating System
On April 6, CMS issued a Memorandum to state survey agency directors regarding the transition to PBJ staffing measures for Nursing Home Compare and the Five Star Quality Rating system. This transition will begin in April 2018, as CMS said it has solved any technical issues preventing full implementation. The memo contains information on calculating staffing ratings, determining staffing measure adjustments, solving common staffing errors found through audits, and further technical assistance.
Effective date: Immediately. This policy should be communicated with all survey and certification staff, their managers, and the State/Regional Office training coordinators within 30 days of this memorandum.
New Topics Proposed for Recovery Audit Review
On April 10, CMS updated its recovery audit program provider resources page with a List of topics proposed for review. The topics include:
- Exact Duplicate Claims
- Implantable Automatic Defibrillators
- Group 3 Support Surfaces
- Percutaneous Implantation of Neurostimulator Electrode Array
Decision Memo for Magnetic Resonance Imaging (MRI)
On April 10, CMS published a Final Decision Memo to approve changes to an NCD in Section 220.2 of the manual to expand coverage of MRIs for Medicare beneficiaries with an implanted pacemaker, implantable cardioverter defibrillator, or a cardiac resynchronization therapy pacemaker.
Notice of New Interest Rate for Medicare Overpayments and Underpayments - 3rd Qtr Notification for FY 2018
On April 10, CMS published Medicare Financial Management Transmittal 303 to provide notification of the new interest rate for the third quarter of FY 2018. The Department of the Treasury notified the Department of Health and Human Services that the private consumer rate has been changed to 10.25%.
Effective date: April 17, 2018
Implementation date: April 17, 2018
Comment Request: Transcatheter Mitral Valve Repair National Coverage Decision; Conditions of Coverage for Portable X-ray Suppliers and Supporting Regulations
On April 10, CMS published a Comment Request in the Federal Register regarding the following information collections:
- Transcatheter Mitral Valve Repair (TMVR) National Coverage Decision (NCD)
- Conditions of Coverage for Portable X-ray Suppliers and Supporting Regulations
Comments on the above information collections are due by June 11, 2018.
Updated List of Excluded Individuals and Entities (LEIE)
On April 10, the OIG updated its LEIE with an updated LEIE database for download and lists of March 2018 exclusions, reinstatements, and profile corrections.
2018 Merit-based Incentive Payment System (MIPS): CMS Web Interface Fact Sheet
On April 10, CMS published a Fact Sheet regarding new details about the CMS Web Interface mode of data submission in 2018. The CMS web interface is one of six ways to submit quality data in the MIPS program, and the fact sheet addresses the benefits of submitting MIPS quality data, eligibility for this manner of data submission, quality measures, and scoring systems.
Reconciling National Coverage Determinations on Positron Emission Tomography (PET) Neuroimaging for Dementia
On April 12, CMS published a Notice in the Federal Register in order to provide further explanation on the NCD for PET neuroimaging for dementia, as required by the court order in Kort v. Burwell. The notice explains why CMS covers one diagnostic test (an FDG PET) for specific patients while only covering another (an amyloid PET) in the context of a clinical study.
Comment Request: Request for Certification in the Medicare/Medicaid Program for Providers of Outpatient Physical Therapy and/or Speech-Language Pathology
On April 13, CMS published a Comment Request in the Federal Register regarding an information collection titled, “Request for Certification in the Medicare/Medicaid Program for Providers of Outpatient Physical Therapy and/or Speech-Language Pathology.” Comments are due to the OMB desk officer by May 14, 2018.
Provider Cost Reporting Forms and Instructions, Chapter 43, Form CMS-1984-14
On April 13, CMS published Provider Reimbursement Manual Transmittal 3 regarding changes to hospice cost reporting forms and instructions as well as a new checkbox that will allow providers to elect and sign the Certification and Settlement Summary page using an electronic signature.
Effective date: Hospice Cost Report changes effective for cost reporting periods ending on or after December 31, 2017
Reimbursing Providers and Health Information Handlers (HIHs) for Additional Documentation
On April 13, CMS published Medicare Program Integrity Transmittal 786 to provide updated instructions to recovery audit contractors performing post-payment reviews regarding the reimbursement to providers for submitting requested medical records.
Effective date: May 14, 2018
Implementation date: May 14, 2018
Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 24.2 Effective July 1, 2018
On April 13, CMS published Medicare Claims Processing Transmittal 4022 to announce the normal update to the NCCI PTP edits. A test file of the latest package of the NCCI PTP edits will be available via the CMS Virtual Data Center on or about May 2, 2018. A final file will be available on or about May 17, 2018.
CMS published MLN Matters 10593 on the same date to accompany the transmittal.
Effective date: July 1, 2018
Implementation date: July 2, 2018
Ambulance Transportation for a Skilled Nursing Facility (SNF) Resident in a Stay Not Covered by Part A - Medicare Benefit Policy Manual, Chapter 10 and Medicare Claims Processing Manual, Chapter 15
On April 13, CMS published Medicare Benefit Policy Transmittal 243 and Medicare Claims Processing Transmittal 4021 to provide clarification on coverage of an ambulance transport for a SNF resident in a stay not covered by Part A (but who has Part B benefits) to the nearest supplier of medically necessary services not available at the SNF.
CMS published MLN Matters 10550 on the same date to accompany the transmittals.
Effective date: July 16, 2018
Implementation date: July 16, 2018
Change in Type of Service (TOS) for CPT Code 77067
On April 13, CMS published One-Time Notification Transmittal 2054 to update the TOS for CPT code 77067 (screening mammography) from indicator “4” (Diagnostic Radiology) to indicator “1” (Medical Care). This change will allow screening mammography claims to be billed without referring physician information on the claim, which is consistent with Medicare’s coverage policy for screening mammograms.
CMS published MLN Matters 10607 on the same date to accompany the transmittal.
Effective date: January 1, 2017
Implementation date: July 2, 2018