This week in Medicare updates—5/3/2023
Electronic Cell-Signaling Treatment
On April 24, CMS published an MLN Fact Sheet regarding Medicare coverage and billing for electronic cell-signaling treatment. Medicare does not cover electronic cell-signaling treatment because Medicare considers it experimental, medically unnecessary, and investigational. The fact sheet discusses similar devices and procedures Medicare covers under certain circumstances, such as peripheral nerve blocks and transcutaneous electrical nerve stimulation (TENS).
Compliance Guidance Update
On April 24, the OIG published a Notice regarding its upcoming plans to modernize Compliance Program Guidance (CPG) documents. The OIG has developed a new format for CPGs and will publish them on the OIG website instead of in the Federal Register. The agency said it would publish a general CPG by the end of 2023 on federal fraud and abuse laws, compliance program basics, operating effective compliance programs, and OIG processes and resources. It said it will begin publishing industry-specific CPGs in 2024 and expects the first two topics addressed will be Medicare Advantage and nursing facilities.
Toolkit: Analyzing Telehealth Claims to Assess Program Integrity Risks
On April 24, the OIG published a Toolkit which is intended to help public and private sector partners (such as Medicare Advantage plan sponsors, Medicaid fraud control units, and other federal healthcare agencies) analyze telehealth claims to identify program integrity risks associated with telehealth services. The toolkit is based on the methodology that the OIG used to develop a report on telehealth program integrity risks from the first year of the COVID-19 pandemic. The toolkit includes detailed descriptions of seven data analysis measures that the OIG used to identify indicators of fraud and abuse. It provides an outline of the steps involved in the data analysis, program integrity measures, and examples of how this process works.
FAQ: CMS Waivers, Flexibilities, and the End of the COVID-19 Public Health Emergency
On April 26, CMS published an FAQ regarding the end of CMS waivers and flexibilities as the COVID-19 PHE expires on May 11. The FAQ addresses the exact ending of the PHE, how CMS will handle payments for COVID-19 vaccines, when enforcement discretion for certain billing policies will end, and more.
CMS also published a Document regarding coverage for COVID-19 tests after the end of the COVID-19 PHE.
Hospital Price Transparency Enforcement Updates
On April 26, CMS published a Fact Sheet regarding the enforcement of hospital price transparency requirements. CMS is updating its enforcement process for certain areas which it said do not require rulemaking. This includes the following:
- Requiring hospitals to be in full compliance with hospital price transparency regulations within 90 days from when CMS issues a corrective action plan (CAP) request
- Automatically imposing a civil monetary penalty (CMP) on hospitals that fail to submit a CAP at the end of the 45-day CAP submission deadline
- For any hospital that has not made any attempt to satisfy the price transparency requirements, CMS will immediately request a CAP instead of initially issuing a warning notice
CMS said that as of April 2023, it has issued more than 730 warning notices, sent 269 requests for CAPs, and imposed CMPs on four hospitals.
Significant Updates to Medicare Secondary Payer Manual, Chapter 6
On April 27, CMS published Medicare Secondary Payer Transmittal 11996 regarding updates to chapter 6 of the manual to add in current terminology and acronyms and to remove outdated policies and procedures. While the transmittal involves changes to language explaining MSP policy and operational procedures, there are no MSP policy or operational changes being made to this chapter in this update.
Effective date: May 29, 2023
Implementation date: May 29, 2023
HCPCS Application Summaries and Coding Recommendations
On April 27, CMS published the First Quarter 2023 HCPCS Application Summaries & Coding Recommendations. The document contains a summary of each HCPCS code application and CMS’ coding decisions for each of the processed applications. All new coding actions will be effective by July 1, 2023, unless otherwise indicated in the document.
Correction to Payment Window Edits for Inpatient Prospective Payment System (IPPS)-Excluded Hospitals and IPPS-Excluded Units
On April 28, CMS published One-Time Notification Transmittal 12006 regarding corrections to CWF editing and conversion of the CMS Certification Number (CCN) for IPPS-excluded hospitals operating IPPS-excluded units.
Effective date: October 1, 2019
Implementation date: October 2, 2023