This week in Medicare updates—4/24/19
Provider Compliance Tips for Ordering Lower Limb Prostheses
On April 15, CMS published an MLN Fact Sheet regarding proper documentation techniques for ordering lower limb prostheses. During the 2018 reporting period, the projected improper payment amount for lower limb prostheses was $46.6 million, and approximately 95% of these improper payments were due to insufficient documentation. Coverage for these prostheses must be supported by the beneficiary’s medical condition and the beneficiary’s ability to effectively utilize the specified prosthetic to achieve a defined functional state.
Updated OIG Work Plan
On April 15, the OIG updated its Work Plan with the following new item:
Comment Request: Home Health Agency Cost Report
On April 16, CMS published a Comment Request in the Federal Register regarding an information collection titled “Home Health Agency Cost Report.” Comments are due by June 17, 2019.
Implementation to Exchange the List of Electronic Medical Documentation Requests (eMDR) for Registered Providers via the Electronic Submission of Medical Documentation (esMD) System
On April 16, CMS published One-Time Notification Transmittal 2281, which rescinds and replaces Transmittal 2264, dated February 21, 2019, to revise the MLN article attachment and background section. The original transmittal was issued regarding the implementation of changes required to send additional documentation request letters to participating providers via the esMD system.
On April 19, CMS published a revised version of MLN Matters 11003 to accompany the transmittal.
Effective date: July 1, 2019
Implementation date: July 1, 2019
Concerns about Opioid Use in Medicare Part D in the Appalachian Region
On April 17, the OIG published a Data Brief regarding opioid use in Medicare Part D in Alabama, Kentucky, Ohio, Tennessee, and West Virginia in 2017. All five states had high opioid prescribing rates, and nearly 7,000 of the reported 42,000 opioid-related overdose deaths in the United States occurred in those five states. The OIG found that 36% of Part D beneficiaries in these five states received a prescription opioid in 2017, and 49,000 of these beneficiaries--excluding those with cancer or in hospice care--received high amounts of opioids that far exceeded levels recommended by the CDC. The OIG concluded that opioids in the Appalachian region may be prescribed for medically unnecessary purposes and diverted for resale and recreational use. It also concluded that beneficiaries in this region may be receiving poorly coordinated care or need to be reassessed.
Proposed Rule: 2020 Payment and Policy Changes for Medicare Inpatient Rehabilitation Facilities
On April 17, CMS published a draft version of the Proposed Rule for the 2020 Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS). The rule contains proposals geared toward eventually transitioning to a unified post-acute care system, and CMS is proposing to revise the case-mix groups based on two years of data from the quality indicator data items, and it would update the relative weights and average length of stay values associated with a revised case-mix grouping beginning October 1, 2019. CMS is also proposing two new quality measures related to interoperability to satisfy the requirements of the IMPACT Act.
CMS published a Fact Sheet on the proposed rule on the same date. Comments on the proposed rule are due by June 17. The rule is scheduled to be published in the Federal Register on April 24.
Proposed Rule: 2020 Medicare Payment and Quality Reporting Updates for Inpatient Psychiatric Facilities
On April 18, CMS published a draft version of the Proposed Rule for the 2020 Inpatient Psychiatric Facility Prospective Payment System (IPF PPS). The proposals include updating total IPF payments by 1.7% in 2020 and setting the market basket update at 3.1%. It would also rebase and revise the IPF market basket to reflect a 2016 base year and introduce a new quality measure for the FY 2021 payment determination on medication compliance following discharge.
CMS published a Fact Sheet on the proposed rule on the same date. Comments on the proposed rule are due by June 17. The rule is scheduled to be published in the Federal Register on April 23.
Draft Only: Clarification of Ligature Risk Interpretive Guidelines--For Action
On April 19, CMS published a Memorandum to state survey agency directors regarding drafted revised guidelines intended to provide increased direction, clarity, and guidance on what constitutes a ligature risk. The policies also address expectations that hospitals achieve ligature “resistant” environments in psychiatric units of acute care hospitals, locked emergency department psychiatric units, and psychiatric hospitals. Revisions would affect Chapter 2 and Appendix A of the State Operations Manual.
CMS is seeking comment on these drafts by June 17, 2019.
Proposed Rule: 2020 Skilled Nursing Facility Prospective Payment System
On April 19, CMS published a draft version of the Proposed Rule for the 2020 Skilled Nursing Facility (SNF) Prospective Payment System (PPS). It is scheduled to be published in the Federal Register on April 25. The rule will align with the new SNF Patient Driven Payment Model (PDPM) case-mix model, which goes into effect October 1, 2019. Some of the proposals from the rule include:
- Sub-regulatory process for ICD-10 code revisions: CMS is proposing to create a subregulatory process for making nonsubstantive changes to the ICD-10 codes used to classify patients into the PDPM’s clinical categories in a way that is similar to the process for HCPCS codes subject to consolidated billing for SNFs and the Inpatient Rehabilitation Facility (IRF) PPS subregulatory process for updating the the presumptive compliance methodology.
- Revised group therapy definitions: CMS is proposing to align the SNF definition of group therapy with the definition used by other post-acute care settings by adopting the IRF PPS definition stating group therapy consists of 2-6 patients doing the same or similar activities.
- SNF Quality Reporting Program: CMS is proposing to adopt two new quality measures related to ways health information is shared. It is also proposing to adopt multiple standardized patient assessment data elements to assess either cognitive function and mental status, special services, treatments and interventions, medical conditions and comorbidities, impairments, or social determinants of health.
CMS published a Fact Sheet on the proposed rule on the same date. Comments are due by June 18, 2019.
Proposed Rule: 2020 Hospice Payment Rate Update
On April 19, CMS published a draft version of the 2020 Hospice Payment Rate Update Proposed Rule. Proposals within the rule target payment accuracy and payment transparency, such as a proposal to modify the existing hospice election statement content requirements to include an addendum of items, drugs, and services that the hospice has determined to be unrelated to the terminal illness and related conditions. CMS is also proposing to use the concurrent IPPS wage index for the hospice wage index to align data across all settings. CMS is soliciting comments on the interaction of the hospice benefit and various alternative care delivery models to consider for future enhancements to the hospice benefit.
CMS published a Fact Sheet on the proposed rule on the same date. Comments are due by June 18, 2019. The rule is scheduled to be published in the Federal Register on April 25.
Update to Pub. 100-04, Chapter 11
On April 19, CMS published Medicare Claims Processing Transmittal 4280 regarding updates to the manual related to the designation of hospice attending physicians. The transmittal also provides updates to the description of a hospice election period versus a benefit period and how the Medicare systems use those terms.
Effective date: July 21, 2019
Implementation date: July 21, 2019
Update to Chapter 28 in Publication 100-04 to Provide Language-Only Changes for the New Medicare Card Project
On April 19, CMS published Medicare Claims Processing Transmittal 4281 regarding changes to the manual to update language related to the new Medicare cards.
Effective date: May 20, 2019
Implementation date: May 20, 2019
MAC Reporting of Issuance of Compliance Letters to Specific Providers and Suppliers Regarding Inappropriate Billing of Qualified Medicare Beneficiaries (QMBs) for Medicare Cost-Sharing
On April 19, CMS published One-Time Notification Transmittal 2280 regarding instructions to MACs to report the number of compliance letters sent to providers from September 1, 2017 - March 31, 2019 within 60 days of the issuance of the transmittal. This reporting will help ensure providers are not erroneously charging individuals enrolled in the QMB for Medicare deductibles, coinsurances, or copays for covered Parts A and B items and services.
Effective date: May 20, 2019
Implementation date: June 21, 2019 - 30 days after issuance for BR3 and BR4; 10 days after the end of each calendar year quarter for BR2 and BR2.1