This week in Medicare updates—4/5/23
Updates to Hospital and Hospital Health Care Complex Cost Report
On March 24, CMS published Medicare Provider Reimbursement Manual Transmittal 19 regarding clarifications and revisions to the hospital and hospital health care complex cost report. This incorporates changes from the Consolidated Appropriations Act of 2023, revises instructions regarding bad debt, adds payment adjustments for domestic NIOSH-approved surgical N95 respirators, and more.
Effective date: Cost reporting periods beginning on or after January 1, 2023
National Coverage Determination (NCD) 50.3 - Cochlear Implantation Manual Update
On March 27, CMS published Medicare National Coverage Determinations Transmittal 11929 and Medicare Claims Processing Transmittal 11929, which rescinds and replaces National Coverage Determinations Transmittal 11875 and Claims Processing Transmittal 11875, both dated February 23, to correct the Section 105 diagnostic code reference in Chapter 32 of the Claims Processing Manual. The original transmittals were published regarding updates to the manuals with the revised eligibility criteria for the cochlear implantation NCD.
CMS revised MLN Matters 13073 to accompany the transmittals.
Effective date: September 26, 2022
Implementation date: March 24, 2023
OIG Featured Topic: Hospice
On March 28, the OIG published a Featured Topic page for hospice. The page describes issues the OIG has identified in recent years regarding hospice and provides resources to ensure these services are provided and billed in a compliant manner.
Updated List of Laboratory Tests Subject to Exceptions to Laboratory Date of Service Policy
On March 29, CMS published the Download Link to the updated list of laboratory tests subject to exceptions to the lab date of service policy.
Increased Use of Telehealth Services and Medications for Opioid Use Disorder During the COVID-19 Pandemic Associated with Reduced Risk for Fatal Overdose
On March 29, CMS published a Press Release regarding a recent Study, which showed that the expanded availability of opioid use disorder-related telehealth services and medications during the COVID-19 pandemic was associated with a lowered likelihood of fatal overdoses among the Medicare population. CMS’ deputy chief medical officer said the study shows CMS needs to continue its efforts to broaden the use of telehealth beyond the pandemic.
Quarterly Update for the DMEPOS Competitive Bidding Program - July 2023
On March 30, CMS published Medicare Claims Processing Transmittal 11930 regarding instructions for the quarterly update to the DMEPOS competitive bidding program files for July 2023.
Effective date: July 1, 2023
Implementation date: July 3, 2023
Updates to Nursing Home Visitation, Infection Control Memorandums Ahead of End of COVID-19 PHE
On March 30, CMS published a Memorandum regarding revised guidance enhanced enforcement for infection control deficiencies at nursing homes. This guidance is an updated version of the policies put in place during the COVID-19 PHE and adds enforcement on noncompliance with infection prevention control combined with COVID-19 vaccine immunization requirements for residents and staff to the criteria for enhanced enforcement of infection control deficiencies that result in no resident harm. The memo also provides guidance to state survey agencies and CMS locations on handling enforcement cases before and after the revisions to these enhanced enforcement policies.
CMS also rescinded a number of memorandums published during the PHE regarding visitation policies and infection control policies specifically geared toward the prevention of COVID-19 at nursing homes. Current guidance is available via QSO-20-39-NH, which was revised on September 23, 2022, or via the CMS current emergencies webpage.
Effective date: Immediately
Updates to Home Health Agency Cost Report
On March 31, CMS published Medicare Provider Reimbursement Manual Transmittal 4 regarding updates to the Home Health Agency cost report to clarify instructions regarding telehealth and add an edit.
Effective date: Cost reporting periods beginning on or after January 1, 2023
Updated EUA for Pfizer Vaccine to Cover Boosters for Infants
On March 30, CMS updated its COVID-19 Toolkit to note that the FDA revised the Emergency Use Authorization (EUA) for the Pfizer COVID-19 vaccines on March 14 to authorize the use of the bivalent vaccine as a single booster dose for children 6 months to 4 years old at least two months after completion of primary vaccination with three doses of a monovalent Pfizer vaccine.
Providers should report code 0174A for this booster dose. This code is effective March 14, 2023. CMS published billing and coding information on its COVID-19 Vaccines and Monoclonal Antibodies page.
CMS Clarification on Impact of Bill to Immediately End Public Health Emergency
On March 31, CMS updated its Current Emergencies page to note that House Joint Resolution 7, a bill to immediately end the COVID-19 national emergency that was declared on March 13, 2020, will not impact the COVID-19 public health emergency (PHE) or any current operations at HHS, as the national emergency and the PHE are two separate things. The bill regarding the national emergency passed the Senate on March 30 and will be sent to President Biden to be signed into law. The Biden administration plans to end the PHE on May 11.
April 2023 Update of the Hospital Outpatient Prospective Payment System (OPPS)
On March 10, CMS published Medicare Claims Processing Transmittal 11897 regarding the April updates to the OPPS. Updates include 23 proprietary laboratory analyses (PLA) coding changes, a slew of updates to COVID-19 vaccine codes, updated language in the manual pertaining to various modifiers, and more.
On March 31, CMS published Medicare Claims Processing Transmittal 11937, which rescinds and replaces Transmittal 11897, to correct the language under the policy information in sections 4e, 5c, and 5g.
Effective date: April 1, 2023
Implementation date: April 3, 2023