This week in Medicare updates—4/3/2019
Updated Civil Monetary Penalties and Affirmative Exclusions
On March 25, the OIG published an updated List of Civil Monetary Penalties and Affirmative Exclusions agreements, including:
- On March 13, Medical Specialists of Kentuckiana, PLLC, of Louisville, Kentucky, reached a $69,776.24 settlement with the OIG to resolve allegations that it submitted claims to Medicare for specimen validity testing, a non-covered service
- On March 13, VerraLab JA, LLC, of Louisville, Kentucky, reached a $125,983.16 settlement with the OIG to resolve allegations that it submitted claims to Medicare for specimen validity testing, a non-covered service
The list also includes settlements from facilities who allegedly employed individuals they knew or should have known were excluded from participation in federal healthcare programs, including:
- MHC, Inc. d/b/a Maplewood Health Care Center, of Jackson, Tennessee
- Sweet Town, LLC d/b/a Cleveland Manor Nursing and Rehabilitation, of Cleveland, Oklahoma
Medicare Market Shares of Non-Mail Order Diabetes Test Strips from April through June 2018
On March 25, the OIG published a Report on the Medicare market shares of diabetes test strips (DTS) provided through the non-mail order market to help inform future rounds of the Competitive Bidding Program. The OIG found that sampled suppliers provided 34 types of DTS via non-mail order to Medicare beneficiaries. The top three strip types accounted for 53% of the Medicare non-mail order market and the top 10 strip types accounted for 93% of the Medicare non-mail order market. These totals are used to determine which suppliers meet the 50% rule.
Activation of Systematic Validation Edits for OPPS Providers with Multiple Service Locations
On March 26, CMS published Special Edition MLN Matters 19007 regarding the activation of systematic validation edits relevant to providers with multiple service locations. The article discusses how to report services based on location at the claim level and line level. The article also discusses the new practice location screen, which will be available in DDE for the April 2019 system quarterly release.
Proposed Decision Memo for Transcatheter Aortic Valve Replacement (TAVR)
On March 26, CMS published a Proposed Decision Memo regarding an NCD on coverage of TAVR procedures for treatment of aortic valve stenosis through Coverage with Evidence Development. The updated NCD would change coverage criteria for hospitals and physicians to begin or maintain a TAVR program and would allow more flexibility for providers to meet the requirements for performing TAVR. By publishing this proposed decision memo, CMS initiates a 30-day public comment period on the policy.
CMS published a Press Release announcing the proposed decision memo on the same date.
Evaluation and Management (E/M) When Performed with Superficial Radiation Treatment
On March 27, CMS published Medicare Claims Processing Transmittal 4267, which rescinds and replaces Transmittal 4246, dated February 22, 2019, to add verbiage to clarify that the 25 modifier needs to be billed when performing E/M services with CPT code 77401. The original transmittal was issued regarding revisions to the manual to allow for billing E/M codes for levels I through III in order to report physician work associated with radiation therapy planning, radiation treatment device construction, and radiation treatment management when performed on the same date of service as superficial radiation treatment delivery.
On March 28, CMS published a revised MLN Matters 11137 to accompany the transmittal.
Effective date: January 1, 2019
Implementation date: March 25, 2019
Transplant Program Survey Activity Transition
On March 29, CMS published a Memorandum to state survey agency directors regarding the transition of survey activity for approval and re-approval of Medicare transplant programs from the federal contractors back to the state survey agencies as of January 1, 2019. The memo provides guidance to state survey agencies on survey activities and expectations for transplant programs, including initial approvals, re-approvals, required notifications to CMS, reasonable assurance, program inactivation, complaint investigations, and more.
Effective date: Immediately. This policy should be communicated with all survey and certification staff, their managers, and state and regional office training coordinators within 30 days of the memorandum.
Announcement of the Approval of the Accreditation Association for Hospitals and Health Systems/Healthcare Facilities Accreditation Program as an Accreditation Organization Under the Clinical Laboratory Improvement Amendments of 1988
On March 29, CMS published a Notice in the Federal Register to announce the approval of the application of the Accreditation Association for Hospitals and Health Systems/Healthcare Facilities Accreditation Program as an accreditation organization under the CLIA program for a period of four years.
Dates: The approval announced in this notice is effective from March 29, 2019 to March 29, 2023.
Updates to Immunosuppresive Guidance
On March 29, CMS published Medicare Program Integrity Transmittal 872 regarding updates to Chapter 4 of the manual to account for recent updates to policies related to the delivery of immunosuppressive drugs to places other than a beneficiary’s home. This policy applies to the initial prescription after discharge from an inpatient facility when beneficiaries do not immediately return home following a transplant.
Effective date: April 3, 2019 - Date aligns with policy update per CR 11072
Implementation date: April 18, 2019
Update to the Internet-Only Manual Publication 100-04, Chapters 1 and 3
On March 29, CMS published Medicare Claims Processing Transmittal 4271 regarding an update to Payer Only Codes in Chapter 1 of the manual and the removal of a duplicate section in Chapter 3 of the manual.
Effective date: April 29, 2019
Implementation date: April 29, 2019
Correction of the Fiscal Year (FY) 2019 Inpatient Prospective Payment System (IPPS) Pricer
On March 29, CMS published Medicare Claims Processing Transmittal 4272 regarding installation of a corrected IPPS Pricer program and MAC adjustments to claims for IPPS hospitals located in counties that are on the list to receive an outmigration adjustment in 2018 to correct inaccurate payments. This was issued in response to a problem CMS recently learned of in which FY 2018 claims from hospitals eligible for an outmigration adjustment did not get correct reimbursement.
CMS published MLN Matters 11208 on the same date to accompany the transmittal.
Effective date: October 1, 2017
Implementation date: July 1, 2019
Update to Section 4.12 in Chapter 4 of Publication 100-08
On March 29, CMS published Medicare Program Integrity Transmittal 871 regarding an update to Section 4.12 in Chapter 4 of the manual to provide instructions related to UPIC workload entry and update requirements in the Unified Case Management system.
Effective date: April 29, 2019
Implementation date: April 29, 2019
Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 25.2 Effective July 1, 2019
On March 29, CMS published Medicare Claims Processing Transmittal 4266 regarding the quarterly update to the NCCI PTP edits.
CMS published MLN Matters 11227 on the same date to accompany the transmittal.
Effective date: July 1, 2019
Implementation date: July 1, 2019
Revision to the Cost Report Acceptability Checklists
On March 29, CMS published One-Time Notification Transmittal 2273 regarding revisions to the acceptability checklist used to determine whether a provider’s cost report is acceptable. These revisions remove the post-acceptability instructions and include steps relating to submissions of cost reports through the Medicare Cost Report e-Filing (MCReF) system.
Effective date: Cost reports received on or after 7/1/2019
Implementation date: Cost reports received on or after 7/1/2019
The Supplemental Security Income (SSI)/Medicare Beneficiary Data for Fiscal Year 2017 for Inpatient Prospective Payment System (IPPS) Hospitals, Inpatient Rehabilitation Facilities (IRFs), and Long Term Care Hospitals (LTCHs)
On March 29, CMS published One-Time Notification Transmittal 2271 regarding updated data for determining the disproportionate share adjustment for IPPS hospitals and low-income patient adjustment for IRFs as well as payments applicable for LTCH discharges.
CMS published MLN Matters 11187 on the same date to accompany the transmittal.
Effective date: April 29, 2019
Implementation date: April 29, 2019