This week in Medicare updates—5/17/2023

May 17, 2023
Medicare Insider

Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Patient-Driven Payment Model (PDPM) Claims Processing Updates to Current Editing

On May 8, CMS published Medicare Claims Processing Transmittal 12023, which rescinds and replaces Transmittal 11988, dated April 21, to revise business requirements 13149.1, 13149.1.1, 13149.2, and 13149.2.1. These changes affect when a MAC would not set a CWF edit to note that it would not happen when a claim has any or all overlapping span dates on the historical inpatient (11X) claim’s date of service and there’s an occurrence span code (OSC) of 74 on the 21X claim. The original transmittal was published regarding updates to claims processing for SNF claims.

CMS revised MLN Matters 13149 on the same date to accompany the transmittal.

Effective date: October 1, 2023 - Dates of service October 1, 2019, and after

Implementation date: October 2, 2023


Nursing Home Visitation - COVID-19

On May 8, CMS revised a Memorandum to state survey agency directors regarding updated guidance for nursing home visitation in light of the end of the PHE. CMS noted that it still expects facilities to adhere to infection prevention and control recommendations that meet national standards, post visual alerts in facilities about infection control standards, and conduct visitation during outbreaks in a way that limits infection exposure. 

Effective date: Immediately. This policy should be communicated with all survey and certification staff, their managers, and the state/CMS locations within 30 days of this memorandum.


OPPS Addendum A and Addendum B Updates

On May 10, CMS published updated Download Links for the April 2023 versions of the OPPS Addendum A and Addendum B files.


CLIA Post-Public Health Emergency (PHE) Guidance

On May 11, CMS published a Memorandum to state survey agency directors regarding the end of certain CLIA flexibilities due to the expiration of the PHE. CMS will no longer require laboratories to report SARS-CoV-2 test results, but it noted labs might have to adhere to other reporting requirements not enforced by CMS. The memo also explores various enforcement discretion areas it exercised during the PHE and discussed whether that enforcement discretion would continue. The memo has a table at the end clearly outlining which enforcement discretions will continue and which will not. 

Effective date: Immediately. Please communicate to all appropriate staff within 30 days.


Quarterly Update to the End-Stage Renal Disease Prospective Payment System (ESRD PPS)

On May 11, CMS published Medicare Claims Processing Transmittal 12029 regarding the quarterly update to the list of outlier services under the ESRD PPS.

Effective date: July 1, 2023

Implementation date: July 3, 2023


Update to the ICD-10 2024 Tables in the CWF for Purposes of Processing Non-Group Health Plan (NGHP) Medicare Secondary Payer (MSP) Records and Claims

On May 11, CMS published Medicare Secondary Payer Transmittal 12028 regarding instructions to the CWF maintainer to upload and implement the ICD-10 tables for 2024 in the CWF for NGHP MSP claims transactions. 

Effective date: October 1, 2023

Implementation date: October 2, 2023


Quarterly Update to the Home Health Grouper 

On May 11, CMS published Medicare Claims Processing Transmittal 12030 regarding the October 2023 updates to the HH Grouper software.

Effective date: October 1, 2023 - claim from dates on or after this date

Implementation date: October 2, 2023


Additional Policy and Regulatory Revisions in Response to the COVID-19 PHE Related to Long-Term Care (LTC) Facility Testing Requirements

On May 11, CMS updated a Memorandum to note the guidance in the memorandum expired effective May 11, 2023. The memo was issued regarding COVID-19 testing requirements for LTC staff and residents. CMS stated that testing for COVID-19 should be conducted according to national standards, and while routine testing of asymptomatic staff is no longer recommended, it may be performed at the discretion of the facility. It also contains information about resident testing and noncompliance citations. 

Effective date: Immediately


Archived COVID-19 Waivers

On May 12, CMS published an Index on its Past Emergencies webpage to note all of the waivers and guidance that were in effect during the COVID-19 PHE. The documents are organized by topic and appear to serve as an archive of the policies in effect during the PHE. 

The page contains a link to a different CMS webpage where CMS plans to keep the active waivers and flexibilities pertaining to COVID-19.