This week in Medicare updates—6/6/2018
National Coverage Analysis (NCA) Tracking Sheet for Vagus Nerve Stimulation (VNS) for Treatment Resistant Depression (TRD)
On May 30, CMS published a Tracking Sheet to initiate an NCA to reconsider Section C., paragraph 2, in NCD 160.18, which states that VNS treatment is not reasonable and necessary for TRD. CMS is reconsidering that coverage in light of new evidence that VNS may benefit TRD patients. The issuance of the tracking sheet initiates a 30-day public comment period, which will end on June 29, 2018. CMS will only reconsider section C., paragraph 2 of NCD 160.18 during this NCA period.
Identifying and Eliminating Discrepancies between the Provider Enrollment, Chain and Ownership System (PECOS) and the Fiscal Intermediary Shared System (FISS)
On May 30, CMS published One-Time Notification Transmittal 2091, which rescinds and replaces Transmittal 2079, dated May 4, 2018, to add a note to business requirement 10564.1.3.
Effective date: October 1, 2018
Implementation date: October 1, 2018
Updated Civil Monetary Penalties and Affirmative Exclusions
On May 31, the OIG published an updated List of Civil Monetary Penalties and Affirmative Exclusion agreements, including:
- Houston County Community Hospital (HCCH), of Erin, Tennessee, reached a $25,000 settlement agreement with the OIG on May 4 to resolve allegations that HCCH violated the EMTALA by delaying provision of an appropriate medical screening examination and failing to provide treatment to stabilize an emergency medical condition in a 58-year-old patient.
- Robert Gennaro, of Woodstock, Georgia, agreed on May 7 to a 10-year exclusion from participation in all federal health care programs to resolve a False Claims Act liability stemming from an OIG investigation, which discovered that Gennaro worked at pain management clinics owned by Dr. Robert Windsor and operated under the umbrella of National Pain Care Inc. The company billed federal health care programs for the professional component of intraoperative monitoring services on behalf of Dr. Windsor when Gennaro was performing the intraoperative monitoring on Dr. Windsor’s behalf.
- Pettis County Ambulance District, of Sedalia, Missouri, reached a $65,580.10 settlement agreement with the OIG on May 21 to resolve allegations that Pettis submitted claims to Medicare for emergency ambulance transportation to destinations such as skilled nursing facilities and patient residences when those ambulance services should have been billed at the lower non-emergency rate.
- Recovery Pathways, LLC, of Essexville, Michigan, reached a $64,555 settlement agreement with the OIG on May 24 to resolve allegations that Recovery Pathways received improper remuneration from Millenium Health, LLC, in the form of point of care test cups which resulted in prohibited referrals.
Advisory Opinion No. 18-03
On May 31, the OIG published an Advisory Opinion on whether a federally qualified health center look-alike would be in violation of the federal anti-kickback statute if it used grant funds received from the state Department of Health to give the county clinic free telemedicine items and services for use in telemedicine encounters related to HIV prevention. In this specific case, the OIG determined that it would not impose administrative sanctions in this case because the proposed arrangement would present a low risk of fraud and abuse under the anti-kickback statute for reasons detailed in the report.
Comment Request: Pre-Claim Review Demonstration for Home Health Services
On May 31, CMS published a Comment Request in the Federal Register regarding an information collection titled, “Pre-Claim Review Demonstration for Home Health Services.” Comments on the information collection are due by July 30, 2018.
E/M Service Documentation Provided by Students (Manual Update)
On May 31, CMS published Medicare Claims Processing Transmittal 4068, which rescinds and replaces Transmittal 3971, dated February 2, 2018, to correct typos to section number 100.1.1 in the transmittal, business requirement 10412.1, and part of the manual update under section 100.1.1. The original transmittal was issued regarding changes to the manual which will allow the teaching physician to verify in the medical record any student documentation of components of E/M services.
Effective date: January 1, 2018
Implementation date: March 5, 2018
Comment Request: Administrative Requirements for Section 6071 of the Deficit Reduction Act
On June 1, CMS published a Comment Request in the Federal Register regarding an information collection titled, “Administrative Requirements for Section 6071 of the Deficit Reduction Act. Comments are due to the OMB desk officer by July 2, 2018.
Meeting of the Advisory Panel on Outreach and Education (APOE)
On June 1, CMS published a Notice in the Federal Register to announce that the next meeting of the APOE will be held on Wednesday, June 20, from 8:30 a.m. to 4:00 p.m. Those who wish to attend the meeting must register via one of the methods listed in the notice by 5:00 p.m. on Wednesday, June 6.
July 2018 Update of the Hospital Outpatient Prospective Payment System (OPPS)
On June 1, CMS published Medicare Claims Processing Transmittal 4064 regarding the changes to billing instructions for various payment policies implemented in the July 2018 OPPS update. The update includes new codes for lab testing, packaging for CPT code 01402 when reported with total knee arthroplasty code 27447, pass-through status for six drugs and biologicals, and more.
Effective date: July 1, 2018
Implementation date: July 2, 2018
July 2018 Integrated Outpatient Code Editor (I/OCE) Specifications Version 19.2
On June 1, CMS published Medicare Claims Processing Transmittal 4065 regarding instructions and specifications for the July 1, 2018 quarterly update to the I/OCE.
Effective date: July 1, 2018
Implementation date: July 2, 2018
July 2018 Update of the Ambulatory Surgical Center (ASC) Payment System
On June 1, CMS published Medicare Claims Processing Transmittal 4067 regarding changes to and billing instructions for payment policies in the July 2018 ASC payment system update. The updates include clarification on the bilateral indicator for a nasal surgery CPT code, six new codes for drugs and biologicals, a new Category III CPT code, and more.
Effective date: July 1, 2018
Implementation date: July 2, 2018
New Q Code for In-Line Cartridge Containing Digestive Enzyme(s)
On June 1, CMS published Medicare Claims Processing Transmittal 4063 to implement a new Level II HCPCS code effective July 1, 2018. The new code and code description is:
- Q9994, in-line cartridge containing digestive enzyme(s) for enteral feeding, each
The billing jurisdiction for the new code will be the durable medical equipment MAC.
Effective date: July 1, 2018
Implementation date: July 2, 2018