This week in Medicare updates—6/24/2020
Update to Chapter 10 of Pub. 100-08 - Model Letter Templates
On June 15, CMS published Medicare Program Integrity Transmittal 10182 regarding changes to the manual for language reflecting updated templates for model approval letters. These changes apply to approval letters, DME approval letter templates, Part A/B certified provider approval letter templates, and Part B non-certified supplier approval letter templates.
Effective date: September 16, 2020
Implementation date: September 16, 2020
How to Use the Medicare Coverage Database
On June 15, CMS published an MLN Booklet regarding how to use the Medicare Coverage Database, which contains all NCDs, LCDs, local articles, and proposed NCD decisions. The booklet walks through ways to access the webpage, how to use various features on the webpage, and helpful hints for locating policy decisions.
How to Use the Medicare National Correct Coding Initiative (NCCI) Tools
On June 15, CMS published an MLN Booklet regarding how to navigate the CMS NCCI webpages, how to work with Medicare code pair edits or medically unlikely edits, and ways to avoid coding and billing errors. The booklet also discusses filtering options and shows how to utilize the Excel files.
Hospitals: CMS Flexibilities to Fight COVID-19
On June 15, CMS updated a Fact Sheet on hospital flexibilities to assist providers in the fight against COVID-19. The updates include new information on waivers for certain physical environment requirements, changes to the appeals timeline for the Comprehensive Care for Joint Replacement Model, and an extended deadline for GME affiliation agreements. New information is marked with double asterisks.
Teaching Hospitals, Teaching Physicians and Medical Residents: CMS Flexibilities to Fight COVID-19
On June 15, CMS updated a Fact Sheet on flexibilities for teaching hospitals during the public health emergency. The updates include an extended deadline for GME affiliation agreements and information on waivers for certain physical environment requirements. New information is marked with double asterisks.
Long Term Care Facilities (Skilled Nursing Facilities and/or Nursing Facilities): CMS Flexibilities to Fight COVID-19
On June 15, CMS updated a Fact Sheet on flexibilities for SNFs in the fight against COVID-19 to add information on modified requirements for paid feeding assistants. New information is marked with double asterisks.
FAQs: Exceptions for Dialysis Facilities Affected by COVID-19
On June 17, CMS published an FAQ document regarding the Extraordinary Circumstances Exception for the ESRD Quality Incentive Program. The FAQ discusses whether facilities can still report data on a voluntary basis, which requirements are excepted from the program, the impact of the exception on scores, and more.
COVID-19 FAQs on Medicare Fee-for-Service Billing
On June 17, CMS updated an FAQ regarding the latest guidance on billing for COVID-19. This round of updates included information on whether cost-sharing for ambulance services is waived, use of modifier -95 on telehealth claims, delays on data collection for the Medicare Ground Ambulance Data Collection System, and more.
CMS continues to update this document on a regular basis. Providers should review frequently for new information.
Comment Request: PACE Quality Data Monitoring and Reporting
On June 17, CMS published a Comment Request in the Federal Register regarding an information collection titled “PACE Quality Data Monitoring and Reporting.” Comments on the information collection are due by August 17, 2020.
COVID-19 Diagnostic Laboratory Tests: Billing for Clinician Services
On June 18, CMS published a Note in MLN Connects regarding reminders for physicians and non-physician practitioners when billing for COVID-19 symptom and exposure assessment as well as specimen collection. These include:
- Use CPT code 99211 to bill assessment and collection provided by clinical staff incident to services unless the claim also includes another E/M code for concurrent services
- Use the CS modifier with 99211 or other E/M codes for assessment and collection to waive cost-sharing
- Contact the MAC if the CS modifier was not included on claims with 99211 on and after March 1, 2020
CMS also noted it will be automatically reprocessing claims billed for 99211 that were denied due to place of service editing.
Market Saturation and Utilization Data Tool
On June 19, CMS published a Fact Sheet regarding Release 11 of the Market Saturation and Utilization Data Tool. This release includes information for 14 different 12-month reference periods across 19 health service areas. It also adds two reference periods for Core-Based Statistical Areas (CBSA), meaning there are a total of four reference periods now for CBSAs. The fact sheet discusses the methodology involved in analyzing the data and shows samples of some of the maps created by the tool.
Updated Corporate Integrity Agreement Documents
On June 19, the OIG published information on a new Corporate Integrity Agreement with the following organization:
Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 26.3, Effective October 1, 2020
On June 19, CMS published Medicare Claims Processing Transmittal 10189 regarding the quarterly update to the NCCI PTP edits. The new file for version 26.3 should be available on or about August 17, 2020.
Effective date: October 1, 2020
Implementation date: October 5, 2020
July 2020 Update of the Ambulatory Surgical Center (ASC) Payment System
On June 19, CMS published Medicare Claims Processing Transmittal 10188 regarding the July updates for the ASC payment system. Updates include new replacement codes for hemodialysis arteriovenous fistula procedures, 11 new CPT Category III codes, a correction to the ASC FB/FC device adjustment amount and procedure payment rates for CPT codes 0548T and 0549T, and more.
Effective date: July 1, 2020
Implementation date: July 6, 2020
Updates to Chapters 4, 6, and 8 of Publication 100-08
On June 19, CMS published Medicare Program Integrity Transmittal 10184 regarding updates to UPIC and Investigations Medicare Drug Integrity Contractor (I-MEDIC) processes and procedures.
Effective date: July 21, 2020
Implementation date: July 21, 2020
Updates to Chapter 1, Payer Only Codes in the Medicare Claims Processing Manual
On June 19, CMS published Medicare Claims Processing Transmittal 10186 regarding the removal of condition codes 60 and 61 from the payer only codes list.
Effective date: July 21, 2020
Implementation date: July 21, 2020
State Operations Manual (SOM) Chapter 2, The Certification Process and Chapter 3, Additional Program Activities
On June 19, CMS published State Operations Provider Certification Transmittal 201 and State Operations Provider Certification Transmittal 202 regarding changes to sections of the manual pertaining to voluntary termination work. These changes have been made as part of the effort to streamline the enrollment process by transitioning certain certification functions from CMS regional locations to MACs and the Provider Enrollment Oversight Group.
Effective date: June 19, 2020
Implementation date: July 27, 2020
Quarterly Update to the Long Term Care Hospital (LTCH) Prospective Payment System (PPS) Fiscal Year (FY) 2020 Pricer
On June 19, CMS published Medicare Claims Processing Transmittal 10191, which rescinds and replaces Transmittal 10060, dated April 24, 2020, to revise the COVID-19 blanket waiver for the LTCH ALOS policy, revise the effective date and policy section, and revise the MAC instructions by adding a new requirement 11742.3 and revising requirement 11742.3.1. The original transmittal was issued regarding an update to the LTCH Pricer which will include the new payment policy for COVID-19.
CMS published MLN Matters 11742 on the same date to accompany the transmittal.
Effective date: For COVID-19 Payment Policies - Admissions on or after 1/27/2020; July 6, 2020 - LTCH DPP - For cost reporting periods beginning on or after October 1, 2019
Implementation date: July 6, 2020
Revising Chapters 3 and 5 of Publication 100-08 to Reflect the Recent Final Rule
On June 19, CMS published Medicare Program Integrity Transmittal 10190 regarding changes to the manual to reflect policies from the CY 2020 ESRD/DME PPS Final Rule. These include regulatory updates pertaining to face-to-face encounters, written order requirements, and more.
Effective date: January 1, 2020
Implementation date: July 1, 2020
ICD-10 and Other Coding Revisions to NCDs--July 2020 Update
On June 19, CMS published One-Time Notification Transmittal 10193, which rescinds and replaces Transmittal 2439, dated February 21, 2020, to remove CPT code 0084U from BR 11655.1 and to remove 0084U and its associated diagnosis codes from the NCD 90.2 Next Generation Sequencing (NGS) spreadsheet. This revision is necessary because the CPT code does not meet the policy criteria in NCD 90.2 for NGS. The original transmittal was issued regarding the July 2020 coding updates to NCDs.
On February 25, CMS published MLN Matters 11655 to accompany the transmittal.
Effective date: July 1, 2020
Implementation date: A/B MACs BR 1-15 days from issuance of correction; March 24, 2020 -
MACs; July 6, 2020 - Shared System Maintainers