This week in Medicare updates—6/26/19

June 26, 2019
Medicare Insider

Improving Access to Medicare Coverage Act of 2019

On March 12, the Improving Access to Medicare Coverage Act of 2019 was introduced as a bill in the House and the Senate under bipartisan sponsorship. The legislation would include any time spent in observation status in a hospital toward the three-day stay requirement to satisfy coverage requirements for skilled nursing facility services.


Updates to the State Operations Manual (SOM) Chapters 2, 3, and 9 to Add Instructions for Organ Transplant Programs

On June 14, CMS published State Operations Provider Certification Transmittal 190 regarding extensive new sections in Chapters 2, 3, and 9 of the SOM which outline instructions for organ transplant programs.  

Effective date: June 14, 2019

Implementation date: June 14, 2019


July 2019 Update of the Ambulatory Surgical Center (ASC) Payment System

On June 14, CMS published Medicare Claims Processing Transmittal 4319 regarding changes to and billing instructions for various payment policies implemented in the July 2019 ASC payment system update. Changes include five new CPT Category III codes, a payment indicator revision for a flu vaccine code, 10 new separately payable drug and biological HCPCS codes, and more. 

Effective date: July 1, 2019

Implementation date: July 1, 2019


July Quarterly Update for 2019 DMEPOS Fee Schedule

On June 14, CMS published Medicare Claims Processing Transmittal 4321 regarding the quarterly update for the DMEPOS fee schedule. The update addresses coding and pricing issues related to therapeutic continuous glucose monitors and the use of modifier -KF.  

Effective date: July 1, 2019

Implementation date: July 1, 2019


CMS Announces Voluntary Appeals Settlement Options for Inpatient Rehabilitation Facilities

On June 17, CMS published an Announcement regarding voluntary appeals settlement options for inpatient rehabilitation facilities (IRF). Beginning June 17, CMS will accept Expressions of Interest (EOI) for a settlement option for certain IRF appeals pending at the MAC, QIC, OMHA, and/or Medicare Appeals Council levels of review. The website details the types of IRFs eligible for this option, CMS payment totals, the settlement process, and the EOI period. The website also includes multiple downloads of informational and template documents. 


Correction: IPPS Proposed Rule

On June 18, CMS published a Correction to the 2020 Inpatient Prospective Payment System proposed rule in the Federal Register to correct a handful of technical errors that appeared in the proposed rule as published in the May 3 edition of the Federal Register. These corrections include fixing a typo in the description of the current policy for determining the base operating DRG payment amounts for sole community hospitals receiving payments under §412.92(d) or a Medicare-dependent, small rural hospital that receives payments under §412.108(c). There was also a correction made to a web link in a section discussing the Medicare and Medicaid Promoting Interoperability Programs. 


2020 Release of ICD-10-CM Codes

On June 21, the CDC published the 2020 ICD-10-CM Code Set. There are 273 additions and 21 deletions from the code set. Changes include many new codes for orbital fractures, pressure-induced deep tissue damage, blood clots in the leg, and external cause codes for different types of legal intervention involving injury. These codes will go into effect October 1, 2019, and will be used through September 30, 2020.


Medicare Could Have Saved Millions of Dollars in Payments for Separately Billed Three-Dimensional Conformal Radiation Therapy Planning Services

On June 21, the OIG published a Report which determined the potential savings to Medicare if billing requirements and system edits had been implemented to prevent additional payments for separately billed 3D-conformal radiation therapy (3D-CRT). Medicare makes a single payment to hospitals for development of a 3D-CRT treatment plan, but billing requirements and system edits do not prohibit or prevent additional payments if planning services are billed on a different date of service. The OIG found that Medicare could have saved $125.4 million from 2008 through 2017 if billing requirements and system edits prevented additional payments for separately billed 3D-CRT planning. The OIG recommends CMS implement system edits and billing requirements similar to those used for IMRT planning (a similar form of radiation therapy) to prevent additional payments for 3D-CRT services billed before the procedure code for the 3D-CRT treatment plan is billed. CMS concurred with the recommendation and said it will consider whether to implement these requirements in the future.