This week in Medicare updates—5/27/2020

May 27, 2020
Medicare Insider

Nursing Home Reopening Recommendations for State and Local Officials

On May 18, CMS published a Memorandum to State Officials regarding reopening recommendations for nursing homes. The memo states that states may choose how to implement the recommendations based on whether the state will apply the guidance state-wide, by region, or by individual nursing homes. It also discusses factors that should be considered when reopening, staffing requirements, access to testing, access to PPE, and local hospital capacity. 

CMS published an FAQ on the same date regarding recommendations for reopening nursing homes. The FAQ addresses reopening policies, visitation, and testing requirements. CMS also published a Press Release on the same date. 

Effective date: Immediately. This policy should be communicated with all survey and certification staff, their managers, and the state/branch training coordinators immediately. 


Application from DNV-GL Healthcare USA, Inc. for Continued Approval of its Critical Access Hospital Accreditation Program

On May 18, CMS published a Notice with Request for Comment in the Federal Register to announce it received an application from DNV-GL Healthcare USA, Inc., for continued recognition as a national accrediting organization for critical access hospitals that wish to participate in Medicare or Medicaid. Comments on the request are due no later than 5 p.m. on June 17, 2020.


Opioid Treatment Programs: Medicare Billing and Payment Fact Sheet

On May 18, CMS published an MLN Fact Sheet regarding billing and payment information for opioid treatment programs (OTP). The fact sheet discusses which services are covered, who can provide OTP services, the billing and payment process, how to enroll in the Medicare Electronic Data Interchange (EDI), beneficiary eligibility, coding information, and more.


MAC COVID-19 Test Pricing

On May 19, CMS published Guidance regarding payment details for the CPT codes for infectious agent detection by nucleic acid tests (87635), and the serology tests (86769 and 86328). MACs established the following test prices for these codes:

  • 87635 - $51.31
  • 86769 - $42.31
  • 86328 - $45.23

HCPCS codes U0003 and U0004 are also effective for high throughput technology testing for dates of service on or after April 14, 2020. Medicare pays $100 for each of those tests when used to diagnose COVID-19. Neither code should be used for antibody testing.


Medicare Continues to Modernize Payment Software

On May 19, CMS published Special Edition MLN Matters 20019 regarding payment grouping and code editing software updates for inpatient rehabilitation facilities (IRF) and skilled nursing facilities (SNF). CMS will be making changes to the IRF CMG Grouper and IRF Pricer for claims with discharge dates on and after October 1, 2020. It will be updating the SNF PDPM Grouper for October 2021. 


COVID-19 Blanket Swing Bed Waiver for Addressing Barriers to Nursing Home Placement for Hospitalized Individuals

On May 20, CMS published Special Edition MLN Matters 20018 regarding how hospitals and CAHs can request approval for swing beds to provide skilled nursing care for hospitalized patients who don’t need acute level care but can’t find nursing home placement during the COVID-19 PHE. It also discusses alternatives to swing bed care for patients who are ready for discharge but cannot find appropriate placement due to the PHE. 


Provider Education for Required Prior Authorization (PA) of Hospital Outpatient Department (OPD) Services

On May 21, CMS published One-Time Notification Transmittal 10155, which rescinds and replaces Transmittal 10061, dated April 24, 2020, to change the effective and implementation dates from May 26, 2020 to June 17, 2020. The original transmittal was issued regarding information MACs are instructed to provide to certain provider types about the new prior authorization requirements for select outpatient hospital department services. 

Effective date: June 17, 2020

Implementation date: June 17, 2020


Contract Year 2021 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, and Medicare Cost Plan Program

On May 22, CMS published a draft copy of the CY 2021 Medicare Advantage and Part D Final Rule, which is scheduled to be published in the Federal Register on June 2. The rule implements certain provisions of the Bipartisan Budget Act of 2018 and 21st Century Cures Act before the CY 2021 bid deadline. It also codifies certain existing CMS policies and other technical changes. This includes allowing Medicare-eligible individuals with ESRD to enroll in MA plans beginning January 1, 2021, amending medical loss ratio (MLR) regulations, adding credits for MA plans towards the percentage of beneficiaries who must reside within required time and distance standards for certain telehealth providers, and more. 

This final rule does not address all of the proposals from the February 2020 proposed rule, as CMS plans to publish a second final rule with less immediate regulatory actions at a later time. CMS will make any provisions adopted in the second final rule applicable no earlier than January 1, 2022 but effective on or before January 1, 2021.

CMS published a Fact Sheet and Press Release on the rule on the same date.   


Updated Corporate Integrity Agreement Documents

On May 22, the OIG published information on a new Corporate Integrity Agreement with:


Updated OIG Work Plan

On May 22, the OIG updated its Work Plan with the following new items:


Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP), and PC Print Update

On May 22, CMS published Medicare Claims Processing Transmittal 10149 regarding updated RARC and CARC lists and instructions to the VMS and FISS to update MREP and PC Print. 

CMS published MLN Matters 11708 on the same date to accompany the transmittal. 

Effective date: October 1, 2020

Implementation date: October 5, 2020


Claim Status Category Codes and Claim Status Codes Update

On May 22, CMS published Medicare Claims Processing Transmittal 10148 regarding updates to claim status category codes and claim status codes in the ASC X12 276/277 Health Care Claim Status Request and Response and ASC X12 277 Health Care Claim Acknowledgment transaction standards for health care claims status requests and responses. 

CMS published MLN Matters 11699 on the same date to accompany the transmittal.

Effective date: October 1, 2020

Implementation date: October 5, 2020


Annual Updates to the Prior Authorization/Pre-Claim Review Federal Holiday Schedule Tables for Generating Reports

On May 22, CMS published Medicare Claims Processing Transmittal 10154 regarding updates to applicable federal holiday schedule tables for the MCS, FISS, and VMS. 

Effective date: January 1, 2021

Implementation date: October 5, 2020


Summary of Policies in the CY 2020 Medicare Physician Fee Schedule (MPFS) Public Health Emergency (PHE) Interim Final Rules

On May 22, CMS published One-Time Notification Transmittal 10160 regarding the two interim final rules that were published pertaining to the PHE. The transmittal reviews policy changes pertaining to telehealth, ESRD frequency limitations, communication technology-based services, direct supervision via interactive telecommunications technology, application of teaching physician regulations, and more.

CMS published MLN Matters 11805 on the same date to accompany the transmittal. 

Effective date: June 12, 2020

Implementation date: June 12, 2020


National Coverage Determination (NCD) 160.18 Vagus Nerve Stimulation (VNS)

On May 22, CMS published National Coverage Determinations Transmittal 10145 regarding new coverage for VNS for TRD through Coverage with Evidence Development trials which meet certain criteria established by NCD 160.18. 

Effective date: February 15, 2019

Implementation date: June 23, 2020


Implementation of Provider Enrollment Provisions in CMS-6058-FC - Phase 1 - Continued Removal/Moving of Instructions from Chapter 15 of Pub. 100-08 to Chapter 10 of Pub. 100-08

On May 22, CMS published Medicare Program Integrity Transmittal 10146 regarding implementation of provider enrollment provisions which require providers and suppliers to disclose certain current and previous affiliations with other providers and suppliers and which provide CMS with additional authority to deny or revoke a provider or supplier’s Medicare enrollment in certain circumstances. It also updates voluntary termination procedures for certified providers and suppliers. 

Effective date: July 24, 2020

Implementation date: July 24, 2020