This week in Medicare updates—5/18/2022
Updated List of Excluded Individuals and Entities (LEIE)
On May 10, the OIG updated its LEIE with an updated LEIE database for download and lists of April 2022 exclusions, reinstatements, and profile corrections.
Adverse Events in Hospitals: A Quarter of Medicare Patients Experienced Harm in October 2018
On May 12, the OIG published a Report regarding adverse events in hospitals in October 2018. The report is a repeat of one done back in 2010 that looked at patient harm from October 2008. In this newer report, the OIG found that 25% of Medicare patients experienced patient harm during their hospital stays in October 2018. Physician reviewers determined that 43% of these harm events could have been prevented if patients had been provided better care. Of the 25% of patients who experienced harm, 12% of patients experienced adverse events that led to longer hospital stays, permanent harm, life-saving intervention or death. The other 13% of patients experienced types of harm that were temporary and required intervention, but did not have longer-lasting effects. The most common types of harm events were related to medication (43%) and patient care issues (23%).
The OIG noted that while HHS has taken steps in the past to improve patient safety in hospitals, it must do more. The OIG issued seven recommendations, three of which applied to CMS. Those included recommendations that CMS update and broaden its lists of hospital-acquired conditions to capture common, preventable, and high-cost harm events; explore expanding the use of patient safety metrics in pilots and demonstrations for health care payment and service delivery; and develop and release interpretive guidance to surveyors for assessing hospital compliance with requirements to track and monitor patient harm.
Elimination of Certificates of Medical Necessity (CMN) & Durable Medical Equipment Information Forms (DIF)
On May 12, CMS published Medicare Claims Processing Transmittal 11414 regarding the elimination of the CMN and DIF forms effective for claims with dates of service on or after January 1, 2023. CMS will reject these claims beginning on that date.
CMS published Special Edition MLN Matters 22002 on the same date to accompany the transmittal.
Effective date: June 13, 2022
Implementation date: June 13, 2022
Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - July 2022 Update
On May 12, CMS published Medicare Claims Processing Transmittal 11408 regarding amended payment files for the July 2022 quarterly update to the MPFSDB.
Effective date: July 1, 2022
Implementation date: July 5, 2022
Proposed Decision Memo: Home Use of Oxygen
On May 12, CMS published a Proposed Decision Memo regarding NCD 240.2 (Home Use of Oxygen). CMS is proposing to amend the period of initial coverage for patients from 120 days to 90 days in order to align with the 90-day statutory time period established in §1834(a)(5)(E) of the Social Security Act.
Comments on the proposed decision memo are due by June 10.
Quarterly Listing of Program Issuances–January Through March 2022
On May 13, CMS published a Notice in the Federal Register regarding the quarterly listing of all CMS manual instructions, substantive and interpretive regulations, and other Federal Register notices that were published from January through March 2022.