This week in Medicare updates—5/13/2020
Medicare 1135 Waivers and Two Interim Final Rules Enabling Health System Expansion
On May 4, CMS published Slides regarding the 1135 waivers and the two interim final rules issued during the COVID-19 pandemic. These slides discuss all of the various changes, whether enacted through the waivers or through the rule-making processes, and their impact on various facility types.
Public Meeting Regarding New and Reconsidered Clinical Diagnostic Laboratory Test Codes for the Clinical Laboratory Fee Schedule for CY 2021
On May 4, CMS published a Notice of Meeting in the Federal Register to announce that it will hold a virtual public meeting on establishing payment amounts for new or substantially revised HCPCS codes under the clinical laboratory fee schedule. The meeting is scheduled for Monday, June 22, from 8:30 a.m. to 5 p.m. ET. The deadline for submitting presentations and written comments is June 4 at 5 p.m. ET.
Meeting Announcement for the Medicare Advisory Panel on Clinical Diagnostic Laboratory Tests
On May 4, CMS published a Notice in the Federal Register to announce the virtual public meeting dates for the Medicare Advisory Panel on Clinical Diagnostic Laboratory Tests. The virtual meeting is scheduled for Wednesday, July 29, 2020, from 8:30 a.m. to 5:00 p.m. ET and Thursday, July 30, 2020, from 8:30 a.m. to 5:00 p.m. ET. The notice also contains various deadlines for registration and presentations.
Application From The Compliance Team for Initial CMS-Approval of its Home Infusion Therapy Accreditation Program
On May 4, CMS published a Notice with Request for Comment in the Federal Register to announce it received an application from The Compliance Team for initial recognition as a national accrediting organization for home infusion therapy suppliers who wish to participate in Medicare. Publication of this notice initiates at least a 30-day public comment period. Comments are due no later than 5 p.m. on June 3, 2020.
Comment Request: Medicare Quality of Care Complaint Form; Quality Improvement Strategy Implementation Plan and Progress Report Form
On May 4, CMS published a Comment Request in the Federal Register regarding the following information collections:
- Medicare Quality of Care Complaint Form
- Quality Improvement Strategy and Implementation Plan and Progress Report Form
Comments are due by July 6, 2020.
Medicare Clarifies Recognition of Interstate License Compacts
On May 5, CMS published Special Edition MLN Matters 20008 regarding physicians and non-physician practitioners covered by interstate licensing compacts who wish to bill MACs for services. The article lists the types of providers who may bill in this manner and the licensure requirements necessary to do so.
Medicare Made $11.7 Million in Overpayments for Nonphysician Outpatient Services Provided Shortly Before or During Inpatient Stays
On May 5, the OIG published a Review of whether Medicare payments to hospital outpatient providers were correct for nonphysician outpatient services provided within three days before the date of admission, on the date of admission, or during an IPPS stay for CYs 2016 and 2017. The OIG found that Medicare made incorrect payments to outpatient providers for 40,984 nonphysician outpatient services provided within the three-day time period before admission, on admission, or during the IPPS stay. These occurred because CWF edits were not designed to accurately identify all potentially incorrect claims, and these resulted in $11.7 million in incorrect payments to hospital outpatient providers during the audit period.
The OIG recommends CMS ensure all necessary information is included in the CWF edits to accurately identify and prevent incorrect payments for these services, recover any overpayments in the reopening period, instruct providers to refund the portion of the money from deductible and coinsurance amounts that may have been incorrectly collected from beneficiaries, notify providers to allow providers to return any overpayments in accordance with this recommendation, and educate outpatient providers on how to correctly bill nonphysician outpatient services provided within three days before the date of admission, on the date of admission, or during IPPS stays. CMS concurred with all recommendations and said it is currently updating the automated system edits to accurately identify and prevent incorrect payments for these services.
Updated Corporate Integrity Agreement Documents
On May 6, the OIG published information on new Corporate Integrity Agreements with:
- Guardian Healthcare Management Services, LLC and Guardian Healthcare Ancillary Services Holdco, LLC Amendment, of Brockway, PA
- Chancelight, Inc. and Early Autism Project, Inc. 04-29-2020 Amendment, of Nashville, TN
- Nosheen Hasan M.D. and Center for Pain Management, S.C., of Milwaukee, WI
The OIG also published information on a closed CIA with:
- Family Dermatology, P.C., Family Dermatology of Pennsylvania, P.C., and Family Dermatology of Delaware, P.A.; Adesokan, Yinka; Nelson, Paula, M.D., of Lilburn, GA
Interim Final Rule Updating Requirements for Notification of Confirmed and Suspected COVID-19 Cases Among Residents and Staff in Nursing Homes
On May 6, CMS published a Memorandum to state survey agency directors regarding an upcoming interim final rule with comment period on additional regulatory revisions and flexibilities during the COVID-19 pandemic. The interim final rule includes increased reporting requirements for skilled nursing facilities and detailed requirements for reporting cases of COVID-19 to the CDC. The memorandum reviews these changes for nursing homes as well as updated survey tools and enforcement mechanisms to ensure compliance.
Effective date: Immediately. This policy should be communicated with all survey and certification staff, their managers, and the state/branch training coordinators immediately.
Medicare Part D Beneficiaries at Serious Risk of Opioid Misuse or Overdose: A Closer Look
On May 7, the OIG published a Review of Part D beneficiaries at serious risk of opioid misuse or overdose in 2017 and what their Medicare claims from 2017 and 2018 showed about their experience with opioids. The OIG found that most Part D beneficiaries at serious risk of opioid misuse or overdose in 2017 continued to receive high amounts of opioids the following year. Approximately 11% had an overdose or adverse effect from an opioid in 2017 or 2018, and about 23% of beneficiaries at serious risk in 2017 received a prescription through Part D for naloxone. However, of the beneficiaries at serious risk in 2017, fewer beneficiaries received extreme amounts or opioids or appeared to be doctor shopping the following year, reflecting some progress by CMS and HHS in its effort to curb the opioid epidemic.
The OIG also published Toolkits on the same date which it uses to calculate opioid levels and identify patients at risk of misuse or overdose.
Comment Request: End Stage Renal Disease Annual Facility Survey Form; Virtual Groups for Merit-Based Incentive Payment System
On May 7, CMS published a Comment Request in the Federal Register regarding the submission for OMB review of the following information collections:
- End Stage Renal Disease Annual Facility Survey Form
- Virtual Groups for Merit-Based Incentive Payment System
Comments are due to the OMB desk officer by June 8, 2020.
Payment Change for Wheelchair Accessories and Seat and Back Cushions Used with Complex Rehabilitative Manual Wheelchairs and Certain Manual Wheelchairs
On May 7, CMS published One-Time Notification Transmittal 10019 regarding the usage of the KU modifier when submitted with Group 3 complex rehabilitative manual wheelchair accessories as instructed per Section 106 of the Further Consolidated Appropriations Act of 2020. The KU modifier must be reported to receive the unadjusted fee schedule amount for these types of wheelchairs.
Effective date: January 1, 2020
Implementation date: July 6, 2020
Hospital Outpatient Therapeutic Services That Have Been Evaluated for a Change in Supervision Level
On May 8, CMS published a Table of hospital outpatient therapeutic services that have been evaluated for changes in supervision levels from CY 2012 to the present. The table lists services by HCPCS codes and notes dates when the services were evaluated for changes in supervision level and the final CMS decision on the service.
National Coverage Determination for Acupuncture
On May 8, CMS published an NCD regarding expanded coverage for acupuncture. Medicare will now cover acupuncture for chronic lower back pain effective for claims with dates of service on and after January 21, 2020. This coverage falls under NCD 30.3.3. Acupuncture for fibromyalgia and osteoarthritis continue to be nationally non-covered indications.
CMS published Medicare National Coverage Determinations Transmittal 10128 on the same date to accompany the NCD announcements.
Effective date: January 21, 2020
Implementation date: June 24, 2020 - A/B MACs; October 5, 2020 - SSM Edits; January 4, 2021 - BR 13 SWF only.
Medicare Pharmacies and Other Suppliers May Temporarily Enroll as Independent Clinical Diagnostic Laboratories to Help Address COVID-19 Testing
On May 8, CMS published Special Edition MLN Matters 20017 regarding ways pharmacies can temporarily enroll as independent clinical diagnostic laboratories during the COVID-19 public health emergency to help increase COVID-19 testing capability. The article discusses the information needed to enroll temporarily as a clinical diagnostic lab and information on the provider enrollment hotlines.
Revision to Language in Chapter 3, Section 3.7.5 (Corrective Action Reporting Requirements) of Publication 100-08
On May 8, CMS published Medicare Program Integrity Transmittal 10100 regarding a revision to allow MACs to upload technical direction letters in either Excel file format or Flat file format.
Effective date: June 9, 2020
Implementation date: June 9, 2020
Remove/Archive Demonstration Code 58 - Inactive Medicare Demonstration Projects Within the MCS and CWF System
On May 8, CMS published Demonstrations Transmittal 10113 regarding the removal/archival of obsolete demonstration code 58.
Effective date: October 1, 2020
Implementation date: October 5, 2020
New Physician Specialty Code for Micrographic Dermatologic Surgery (MDS) and Adult Congenital Heart Disease (ACHD) and a New Supplier Specialty Code for Home Infusion Therapy Services
On May 8, CMS published Medicare Claims Processing Transmittal 10124 and Medicare Financial Management Transmittal 10124 regarding a new physician specialty code for MDS (D7) and ACHD (D8) as primary or secondary specialty codes and a new supplier specialty code for home infusion therapy services (D6).
Effective date: October 1, 2020
Implementation date: October 5, 2020
Updates in the Fiscal Intermediary Shared System (FISS) Inpatient and Outpatient Provider Specific Files (PSF)
On May 8, CMS published Medicare Claims Processing Transmittal 10121 regarding changes in the IPPS and OPPS PSF due to changes to the wage index policy. CMS will add two additional fields for the supplemental wage index and supplemental wage index flag into both PSFs.
Effective date: October 1, 2020 - For IPPS and LTCH PPS; January 1, 2021 - For OPPS
Implementation date: October 5, 2020 - for IPPS and LTCH PPS; January 4, 2021 - For OPPS
Implement Error Tracking into the Recovery Audit Contractor (RAC) Data Warehouse (RACDW) Non-RAC Prepayment File Layout
On May 8, CMS published One-Time Notification Transmittal 10110 regarding a change that will implement error tracking into the RACDW non-RAC prepayment file layout by adding identifying fields to the records included in automated files sent to the RACDW.
Effective date: October 1, 2020; January 1, 2021 - For Business Requirement #14 - For calls following implementation
Implementation date: October 5, 2020; January 4, 2021 - For Business Requirement #14 - For calls following implementation
Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - July 2020 Update
On May 8, CMS published Medicare Claims Processing Transmittal 10120 regarding the July 2020 updates to the MPFSDB.
Effective date: January 1, 2020
Implementation date: July 6, 2020
Value-Based Insurance Design (VBID) Model - Implementation
On May 8, CMS published Demonstrations Transmittal 10127 regarding an Innovation Center test incorporating the Medicare hospice benefit into Medicare Advantage through the VBID Model for CY 2021. The hospice benefit component of the model will be tested through 2024.
Effective date: January 1, 2021
Implementation date: October 5, 2020 - Analysis, Design and Coding; January 4, 2021 - Testing and Implementation for all contractors. MCS and VMS: all work to be completed in January.
Update to the Federally Qualified Health Center (FQHC) Prospective Payment System (PPS) for Calendar Year (CY) 2020 - Recurring July File Update
On May 8, CMS published Medicare Claims Processing Transmittal 10122, which rescinds and replaces Transmittal 10059, dated April 24, 2020, to revise the background and policy sections and add business requirement 11770.2. The original transmittal was issued regarding updates to the FQHC PPS to implement a provision of the Families First Coronavirus Response Act that will waive coinsurance for services related to COVID-19 testing. FQHCs must put modifier -CS on claims for which the coinsurance is waived.
Effective date: July 1, 2020
Implementation date: July 6, 2020
Extension of Payment for Section 3712 of the CARES Act
On May 8, CMS published One-Time Notification Transmittal 10116 regarding provisions of the CARES Act which impacts non-rural fee schedule amounts for HCPCS codes for DMEPOS items and services that are adjusted based on payments determined under the DMEPOS Competitive Bidding Program. The KE modifier is also being brought back into use for claims impacted by this provision of the CARES Act.
CMS published MLN Matters 11784 on the same date to accompany the transmittal.
Effective date: October 1, 2020
Implementation date: October 5, 2020
User CR: ViPS Medicare System (VMS) - Update Waiver of Liability Claim Edits 6142 and 6143
On May 8, CMS published One-Time Notification Transmittal 10105 regarding updates to plug the claim line review code based on the GA modifier when waiver of liability claims edits 6142 and 6143 are generated.
Effective date: October 5, 2020 - Business Requirements are effective upon implementation
Implementation date: October 5, 2020
Updates to Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM) to Correct the Adjustment Process
On May 8, CMS published One-Time Notification Transmittal 10109 regarding implementation of requirements for adjustment for the variable per diem to pay correctly and to add new fields to the account for prior days processing.
CMS published MLN Matters 11727 on the same date to accompany the transmittal.
Effective date: October 1, 2019
Implementation date: October 5, 2020
Expand Retention of Claims History for Outpatient, Part B, and DMEPOS to 5 Years
On May 8, CMS published One-Time Notification Transmittal 10104 regarding the expanded retention of outpatient, Part B, and DMEPOS claims history within the CWF for up to five years or 60 months.
Effective date: April 1, 2021
Implementation date: October 5, 2020 - Development; January 4, 2021 - Testing; April 5, 2021 - Implementation
User Change Request (UCR): Implementation Requirements for Analysis UCR 10766 - Reduce Unmailable Medicare Summary Notices (uMSNs) Created in the Fiscal Intermediary Shared System
On May 8, CMS published One-Time Notification Transmittal 10106 regarding changes which will address how FISS creates the shell beneficiary record for the first claim received for a beneficiary to ensure an MSN is not generated for mailing if a valid address has not been received.
Effective date: October 1, 2020
Implementation date: October 5, 2020