This week in Medicare updates—4/4/18
2018 MIPS Improvement Activities Fact Sheet
On March 27, CMS published a Fact Sheet regarding the improvement activities performance category under the Merit-based Incentive Payment System (MIPS) for 2018. The fact sheet reviews the basics of the quality payment program, the 2018 scoring system for MIPS, types of improvement activities available during 2018, and what participants must do to complete the improvement activities performance category in 2018. The fact sheet also discusses a way to receive improvement activity credit by participating in a CMS study.
2018 Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS Survey via CMS-Approved Survey Vendor Reporting
On March 27, CMS published a Fact Sheet regarding the CAHPS for MIPS Survey option as well as a Sample Copy of a survey for providers to use as an example of how the survey works. The CAHPS survey measures patient experience and care within a group, and therefore the fact sheet and sample copy is only applicable to those participating in MIPS as a group of two or more eligible clinicians. The survey also counts as an optional measure within the quality performance category and, if selected, fulfills the high priority measure requirement for groups.
Skilled Nursing Facility (SNF) Value-Based Purchasing (VBP) Program Updated
On March 28, CMS published Special Edition MLN Matters 18003 regarding updates to the SNF VBP Program. These updates include scoring and operational updates, such as a 2% reduction in the adjusted federal per diem rate, distribution of incentive payments to SNFs equivalent to the 60% of the total amount withheld from SNF payments for that fiscal year, and the posting of the SNF 30-Day All Cause Readmission Measure from CY 2015 to the Nursing Home Compare and SNF VBP Program websites. The article also discusses updates to the payment exchange function, review and corrections process, FY 2020 performance and baseline periods, and public reporting policies.
Effective date: N/A
Implementation date: N/A
Proper Coding for Specimen Validity Testing Billed in Combination with Drug Testing
On March 29, CMS published Special Edition MLN Matters 18001 to remind laboratories and other providers of how to properly bill for specimen validity testing done in conjunction with drug testing. The article identifies which codes to use for presumptive drug testing and clarifies when codes cannot be reported together.
Effective date: N/A
Implementation date: N/A
Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Items; Update to the Master List of Items Frequently Subject to Unnecessary Utilizations
On March 30, CMS published a Notice in the Federal Register regarding the deletion of four HCPCS codes from the Master List of Items Frequently Subject to Unnecessary Utilization that could potentially be subject to Prior Authorization as a condition of payment. These codes include:
- E0260, hospital bed semi-electric (head and foot adjustment) with any type side rails with mattress
- E0601, Continuous Airway Pressure (CPAP) Device
- E1390, Oxygen Concentrator
- K0004, High strength, lightweight wheelchair
These codes should be removed from the Master List because they no longer have a DMEPOS Fee Schedule price of $1,018 or greater or an average monthly rental fee schedule of $102 or greater.
Effective date: April 30, 2018
Institutional Billing for No Cost Items
On March 30, CMS published Medicare Claims Processing Transmittal 4013 to clarify billing instructions in the manual for Institutional Billing for No Cost Items. The clarification addresses what providers should do when filing an OPPS claim when they would be required to bill a no cost item due to claims processing edits that require the item to be billed along with an associated service.
CMS published MLN Matters 10521 on the same date to accompany the transmittal.
Effective date: January 1, 2009
Implementation date: June 29, 2018
Update to Chapter 15 of the Medicare Program Integrity Manual - Medicare Enrollment Deactivation Policies
On March 30, CMS published Medicare Program Integrity Transmittal 782 to update the Medicare Enrollment Deactivation Policies in Chapter 15 of the manual in order to align them with 42 CFR 424.540 - Deactivation of Medicare billing privileges.
Effective date: April 2, 2018
Implementation date: April 30, 2018
Reviewing for Adverse Legal Actions (ALA)
On March 30, CMS published Medicare Program Integrity Transmittal 784 to update Chapter 15 of the Medicare Program Integrity Manual to include information and resources to assist the MACs in reviewing final adverse actions while processing provider enrollment applications. The transmittal also includes information in a table on when and what kind of ALAs should be reported.
Effective date: April 30, 2018
Implementation date: April 30, 2018
Proof of Delivery Exceptions for Immunosuppressant Drugs Paid Under the Durable Medical Equipment (DME) Benefit
On March 30, CMS published Medicare Program Integrity Transmittal 783 regarding an exception which will allow immunosuppressant drugs paid under the DME benefit to be delivered to a beneficiary’s home address up to two days prior to the patient’s anticipated discharge from an inpatient stay. This exception was created to ensure that the beneficiary has access to life-sustaining medications upon discharge to their home location.
Effective date: August 1, 2016
Implementation date: April 30, 2018
Skilled Nursing Facility Advance Beneficiary Notice of Non-Coverage (SNF ABN)
On March 30, CMS published Medicare Claims Processing Transmittal 4011 to revise the SNF ABN Form CMS-10055. CMS is discontinuing the 5 SNF Denial Letters and the Notice of Exclusion from Medicare Benefits (NEMB-SNF) Form CMS-20014. SNFs will continue to use the Advance Beneficiary Notice of Non-coverage (ABN, Form CMS-R-131) for items or services that Medicare may deny under Medicare Part B.
CMS published MLN Matters 10567 on the same date to accompany the transmittal.
Effective date: April 30, 2018 - Please note that SNFs may start to implement this new notice any time up to the effective date, which will then be mandatory for use.
Implementation date: April 30, 2018 - Please note that SNFs may start to implement this new notice any time up to the implementation date, which will then be mandatory for use.