This week in Medicare updates—5/11/2022
Advisory Opinion 22-10, Modification to Advisory Opinion 15-14
On May 2, the OIG published an Advisory Opinion to modify a past Advisory Opinion (AO 15-14) to include the Requestor’s proposal to provide financial assistance for certain past MRI tests. The new Advisory Opinion also includes an opinion on a second arrangement from the same Requestor involving distribution of certain cooling and mobility items ancillary to the arrangement addressed in AO 15-14. The Requestor is asking whether the new elements of the arrangement would be grounds for the imposition of sanctions under the anti-kickback statute or beneficiary inducements CMP.
The OIG determined that the proposed modification pertaining to the MRI would not materially affect the risk level of the current arrangement, and therefore it would not impose sanctions under the beneficiary inducements CMP for the same reasons provided in AO 15-14. The OIG also determined that while the distribution program may generate prohibited remuneration under the anti-kickback statute and beneficiary inducements CMP, the OIG would not impose sanctions in this case due to reasons provided in the Opinion.
Updates to Chapters 3, 18, and 32 of the Claims Processing Manual
On May 2, CMS published Medicare Claims Processing Transmittal 11392, which rescinds and replaces Transmittal 11348, dated April 7, 2022, to revise the background section. The original transmittal was published regarding updates to the Inpatient Hospital Billing, Preventive and Screening Services, and Billing Requirements for Special Services chapters of the manual.
Effective date: May 9, 2022 - Unless otherwise specified, it is effective for all dates of service
Implementation date: May 9, 2022 - Unless otherwise specified, it is effective for all dates of service
Approval of Application by The Joint Commission (TJC) for Continued CMS-Approval of its Hospital Accreditation Program
On May 2, CMS published a Final Notice in the Federal Register to announce its decision to approve The Joint Commission for continued recognition as a national accrediting organization for hospitals that wish to participate in Medicare or Medicaid.
Dates: This notice is effective from July 15, 2022, through July 15, 2025.
ICD-10 and Other Coding Revisions to NCDs–October 2022 Update
On May 4, CMS published One-Time Notification Transmittal 11400 regarding the maintenance update of ICD-10 conversions and other coding updates specific to NCDs. This batch of updates affects NCDs for intensive cardiac rehabilitation, next generation sequencing, vagus nerve stimulation, medical nutrition therapy, and autologous blood-derived products for chronic non-healing wounds.
CMS published MLN Matters 12705 on the same date to accompany the transmittal.
Effective date: October 1, 2022 - or as indicated in individual business requirements
Implementation date: October 3, 2022
Quarterly Update to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS)
On May 4, CMS published Medicare Claims Processing Transmittal 11401 regarding the quarterly update to the ESRD PPS. Changes include revisions to the list of outlier services to include 27 NDCs effective January 1, 2022. They also include routine changes effective July 1, 2022, such as revising the mean dispensing fee of the NDCs qualifying for outlier to $0.57 per NDC per month.
CMS published MLN Matters 12741 on the same date to accompany the transmittal.
Effective date: July 1, 2022
Implementation date: July 5, 2022
Revisions to Medicare Part B Coverage of Pneumococcal Vaccinations for the Benefit Policy Manual, Chapter 15, Section 50.4.4.2
On May 4, CMS published Medicare Benefit Policy Transmittal 11399 regarding changes to the manual to reflect updated coverage requirements for pneumococcal vaccinations. CMS changed coverage requirements for these vaccines last year to align with new Advisory Committee on Immunization Practices (ACIP) recommendations. These recommendations differ based on age and other risk factors.
On May 9, CMS published MLN Matters 12723 to accompany the transmittal.
Effective date: July 1, 2021
Implementation date: June 6, 2022
Indian Health Services (IHS) Hospital Payment Rates for CY 2022
On May 4, CMS published Medicare Claims Processing Transmittal 11397 regarding the annual update for IHS payment rates for 2022. In the lower 48 states, the Medicare Inpatient Ancillary Part B rate is $813 and the Outpatient Per Visit rate is $541. In Alaska, the Inpatient Ancillary Part B rate is $1,138 and the Outpatient Per Visit rate is $792.
Effective date: January 1, 2022
Implementation date: August 4, 2022
Quarterly Update for CLFS and Laboratory Services Subject to Reasonable Charge Payment
On May 4, CMS published Medicare Claims Processing Transmittal 11398 regarding the quarterly update to the CLFS. Updates include nine new proprietary laboratory analysis (PLA) codes effective July 1, 2022 as well as information on where to find updates pertaining to Advanced Diagnostic Laboratory Tests (ADLT).
CMS published MLN Matters 12737 on the same date to accompany the transmittal.
Effective date: July 1, 2022
Implementation date: July 5, 2022
Limited Authorization for Use of Janssen COVID-19 Vaccine
On May 5, the FDA published a Press Release announcing it is limiting the use of the Janssen COVID-19 vaccine to individuals 18 years of age or older who cannot access another approved COVID-19 vaccine or who otherwise would not receive a COVID-19 vaccine. This limited use is due to the risk of thrombosis with thrombocytopenia syndrome. CMS updated the Janssen EUA and the Fact Sheet for Healthcare Providers for the Janssen vaccine in various places throughout the COVID-19 section of its webpage to reflect this information.