This week in Medicare updates—5/29/18
MEDCAC Meeting: Transcatheter Aortic Valve Replacement (TAVR) Questions Posted
On May 22, CMS published the Voting Questions for a July 25 convening of the MEDCAC panel to assess whether scientific evidence supports introducing pre-specified volume requirements for TAVR procedures. The questions relate to how volume requirements could be implemented for hospitals, operators, and heart teams to begin and/or maintain TAVR programs.
Quality Payment Program Clinician Champions
On May 22, CMS published a Fact Sheet regarding the Quality Payment Program (QPP) Clinician Champion initiative. CMS is looking for clinicians to volunteer to help educate other clinicians and generate awareness about the QPP across the country. The fact sheet states that volunteers will spend approximately 4-6 months in the role and details some responsibilities of the position.
CMS also published a Nomination Form on the same date for anyone interested in volunteering. The form must be submitted along with a resume to QPPchampions@Lewin.com by June 8, 2018.
Corrections: CY 2018 Updates to the Quality Payment Program; and Quality Payment Program: Extreme and Uncontrollable Circumstance Policy for the Transition Year
On May 22, CMS published a Correction Notice in the Federal Register to correct multiple technical errors in the CY 2018 Quality Payment Program Final Rule. The numerous technical errors affect the preamble, regulation text, and appendices of the final rule and include incorrect percent values for the advancing care information performance category and the improvement activities performance category, incorrect identification of the date of the beginning CY performance period for which CMS calculates a quality improvement score for an alternative payment model entity, inadvertent omissions of high priority symbols from some measures, and more.
Dates: This correction is effective May 22, 2018.
Comment Request: Medicare Current Beneficiary Survey
On May 23, CMS published a Comment Request in the Federal Register regarding an information collection titled, “Medicare Current Beneficiary Survey.” Comments on the information collection are due to the OMB desk officer by June 22, 2018.
Updated Civil Monetary Penalties and Affirmative Exclusions
On May 23, the OIG published an updated List of Civil Monetary Penalties and Affirmative Exclusion agreements, including:
- Southeastern Regional Medical Center (SRMC), of Lumberton, North Carolina, reached a $200,000 settlement agreement with the OIG on April 2 to resolve allegations that SRMC violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide an appropriate medical screening exam, stabilizing treatment, and/or appropriate transfer on four separate occasions involving four separate patients.
- Alameda Health System (AHS), of California, reached a $257,874 settlement agreement with the OIG on May 4 to resolve allegations that AHS employed an eligibility clerk who was excluded from participating in any federal health care programs.
- Immediate Home Care (IHC), of Bensalem, Pennsylvania, reached a $189,445.68 settlement agreement with the OIG on May 17 to resolve allegations that IHC employed a home health nurse who was excluded from participating in any federal health care programs.
Updated Corporate Integrity Agreement Documents
On May 24, the OIG published information on a new Corporate Integrity Agreement with Pfizer Inc., of New York.
Round 2 Competitive Bidding for Oxygen: Continued Access for Vast Majority of Beneficiaries
On May 24, the OIG published a Review of whether Round 2 of the Competitive Bidding Program (CBP) negatively affected beneficiaries’ access to durable medical equipment in the form of oxygen equipment. The OIG concluded that Round 2 of the CBP did not appear to have disrupted access to oxygen equipment or contents for the vast majority of beneficiaries. However, the OIG did find that the percentage of beneficiaries for whom Medicare payments for oxygen equipment did not continue was slightly higher in Round 2 competitive bidding areas than in non-competitive bidding areas, but the OIG was not able to definitively determine that this difference indicated disruptions in receiving needed oxygen equipment, as this may have been due to the program successfully reducing the provision of unnecessary oxygen equipment and contents.
Round 2 Competitive Bidding for Enteral Nutrition: Continued Access for Vast Majority of Beneficiaries
On May 24, the OIG published a Review of whether Round 2 of the Competitive Bidding Program (CBP) negatively affected beneficiary access to durable medical equipment in the form of enteral nutrition supplies. The OIG concluded that Round 2 of the CBP did not appear to have disrupted access to this equipment for the vast majority of beneficiaries, as 91% of beneficiaries receiving these supplies before the Round 2 began continued to receive these supplies after Round 2 began. That number is comparable -- albeit slightly lower -- than the 94% continuation rate in non-competitive bidding areas. However, the OIG was unable to definitively determine that this difference indicated disruptions in receiving necessary supplies, as it is possible that the program reduced the provision of unnecessary enteral nutrition supplies to beneficiaries.
Announcement of the Reapproval of the Joint Commission as an Accreditation Organization Under the Clinical Laboratory Improvement Amendments of 1988
On May 24, CMS published a Notice in the Federal Register to announce that it has approved the continuation of the Joint Commission to serve as a deeming authority for a period of six years.
Effective date: This notice is effective from May 25, 2018 to May 28, 2024.
Diagnosis Code Update for Add-On Payments for Blood Clotting Factor Administered to Hemophilia Inpatients
On May 24, CMS published Medicare Claims Processing Transmittal 4062, which rescinds and replaces Transmittal 3990, dated March 1, 2018, to correct the code description of ICD-10-CM code D68.32 in the background section of the requirements. The original transmittal noted that effective July 1, 2018, ICD-10-CM code D68.32 (hemorrhagic disorder due to extrinsic circulating anticoagulants) will not receive an add-on payment under the hemophilia clotting factor criteria.
On May 25, CMS publish a revised MLN Matters 10474 to accompany the new transmittal.
Effective date: July 1, 2018
Implementation date: July 2, 2018
2019 ICD-10-PCS Codes Published to CMS Website
On May 24, CMS announced in its MLN Connects newsletter that it has posted the 2019 ICD-10-PCS code files to its Website. These codes are to be used for discharges occurring from October 1, 2018, through September 30, 2019.
July 2018 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
On May 25, CMS published Medicare Claims Processing Transmittal 4061 to provide the normal quarterly update to the ASP and Not Otherwise Classified (NOC) drug pricing files for Medicare Part B drugs.
Effective date: July 1, 2018
Implementation date: July 2, 2018
New Medicare Beneficiary Identifier (MBI): Get It, Use It
On May 25, CMS published Special Edition MLN Matters 18006 regarding the implementation of new Medicare cards and the new MBI numbers. The article discusses ways provider offices can get the MBIs, provides sample images of the new cards, and explains how to handle the MBI numbers on claims and appeals.
Effective date: N/A
Implementation date: N/A