This week in Medicare updates—4/19/23
FY 2024 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) PPS Proposed Rule
On April 10, CMS published a draft copy of the FY 2024 IPPS Proposed Rule, which is scheduled to be published in the Federal Register on May 1. CMS projects an increase in operating payment rates of 2.8% based on a projected hospital market basket update of 3.0% reduced by a 0.2% productivity adjustment. CMS projects that disproportionate share hospital (DSH) payments, however, will decrease by approximately $115 million.
Other policies proposed in the rule include:
- CMS is not proposing to extend the New COVID-19 Treatment Add-On Payments (NCTAP) beyond the previously established end date, which was the end of the fiscal year in which the PHE terminates. With the current plan to end the PHE on May 11, that means NCTAP would expire on September 30.
- For the regular New Technology Add-on Payment (NTAP) program, CMS is proposing to move the FDA approval deadline from July 1 to May 1 beginning with applications for FY 2025. CMS is considering 19 applications for NTAP under the traditional pathway and 20 for the alternative pathway for FY 2024.
- CMS proposed 395 new, 13 revised, and 25 deleted ICD-10-CM codes for FY 2024. Many of these changes apply to W codes for capturing accidents and injuries. Changes also affect codes for Parkinson’s disease, new codes for osteoporosis with pelvic fractures, additional sickle cell anemia codes, and more.
The rule also contains a variety of quality reporting program changes and changes to graduate medical education (GME) payments for training in the new rural emergency hospital (REH) provider type. CMS included a Request for Information in the rule regarding challenges faced by safety-net hospitals and ways CMS could help.
CMS published a Press Release and Fact Sheet to accompany the rule. Comments are due by June 9.
Resources for End of COVID-19 PHE
On April 10, CMS updated its COVID-19 Provider Toolkit with information throughout on billing and coding for COVID-19 vaccines and antibody treatments before and after the end of the COVID-19 PHE. The changes talk about how EUAs are distinct from and not dependent on the PHE itself, review what will happen to payment rates when the EUAs end, payment rates for providing vaccines in a patient’s home through the end of 2023, and more.
Prior Authorization for Facet Joint Interventions
On April 11, CMS updated its list of HCPCS codes requiring prior authorization to add facet joint interventions to that list effective July 1, 2023. Providers can start submitting the prior authorization requests on June 15 for dates of service on or after July 1.
Notice of New Interest Rate for Medicare Overpayments and Underpayments – 3rd Qtr FY 2023
On April 11, CMS published Medicare Financial Management Transmittal 11945 regarding the updated interest rate for Medicare overpayments and underpayments. The latest private consumer rate has been changed to 11.50%.
Effective date: April 17, 2023
Implementation date: April 17, 2023
ICD-10 and Other Coding Revisions to NCDs–July 2023 Update
On April 12, CMS published One-Time Notification Transmittal 11952, which rescinds and replaces Transmittal 11884, dated March 1, to remove the A/B MACs (Part A) and FISS from BR 13070.1 and to revise NCD 20.4 Implantable Automatic Defibrillators spreadsheet. The original transmittal was published regarding the regular quarterly updates to ICD-10 conversions and other coding updates for NCDs.
CMS revised MLN Matters 13070 to accompany the transmittal.
Effective date: July 1, 2023 - Unless otherwise stated in individual business requirements
Implementation date: March 3, 2023 - MAC local edits; July 3, 2023 - Shared System Maintainers
Implementation of a National Fee Schedule for Medicare Part B Vaccine Administration
On April 13, CMS published One-Time Notification Transmittal 11954, which rescinds and replaces Transmittal 11710, dated November 17, 2022, to add effective and implementation dates to accommodate MAC testing for the January UAT timeframe, to clarify the testing in BRs 12943.4 and 12943.4.1, remove BRs 12943.5 - 12943.5.2, revise BRs 12943.6 and 12943.8, remove VDCs from 12943.1, and add BRs 12943.2 and 12943.10. The original transmittal was published regarding instructions for downloading, testing, and implementing the annual Part B Preventive Vaccine Administration file.
CMS revised MLN Matters 12943 to accompany the transmittal.
Effective date: January 1, 2023; January 1, 2024 - MAC Testing
Implementation date: April 3, 2023; January 2, 2024 - MAC Testing
Outpatient Rehabilitation Claims with Reason Code W7072
On April 13, CMS published a note in MLN Connects regarding a system change which is causing an error in which outpatient claims on bill types 74x and 75x billing for CPT codes 98980 and 98981 and returning with reason code W7072 incorrectly. CMS is bypassing the reason code for these claims until it corrects the issue in the July 2023 I/OCE update. It is instructing providers to resubmit claims that were returned in error.