This week in Medicare updates—6/9/2021
Comment Request: Verification of Clinic Data—Rural Health Clinic Form and Supporting Regulations; Psychiatric Unit Criteria Work Sheet; more
On June 1, CMS published a Comment Request in the Federal Register regarding the submission of the following information collections for OMB review:
- Verification of Clinic Data--Rural Health Clinic Form and Supporting Regulations
- Psychiatric Unit Criteria Work Sheet
- CMS Identity Management (IDM) System
Comments are due to the OMB desk officer by July 1.
Comment Request: Medicare Severity Diagnosis Related Groups Reclassification Request (MS-DRGs); more
On June 1, CMS published a Comment Request in the Federal Register regarding the following information collections:
- Medicaid State Plan Base Plan Pages
- Medicare Severity Diagnosis Related Groups Reclassification Request (MS-DRGs)
Comments are due by August 2.
OIG Announces Two New COVID-19 Enforcement Actions
On June 1, the OIG published in coordination with the DOJ two announcements on COVID-19 fraud enforcement actions. The first Press Release discusses criminal charges from the DOJ against 14 defendants as well as CMS administrative actions against over 50 medical providers for their involvement in health care fraud schemes relating to COVID-19 or abuse of CMS programs that were intended to encourage access to medical care during the pandemic.
The second Press Release reminds providers in Wisconsin that the public should not be asked to pay any costs to receive the COVID-19 vaccine and warns providers against seeking payment from individual COVID-19 vaccine recipients.
Correction Notice: CY 2022 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, and Medicare Cost Plan Program
On June 2, CMS published a Correction Notice in the Federal Register regarding the CY 2022 Policy and Technical Changes to the Medicare Advantage Program Final Rule, which was published in the Federal Register on January 19. The notice makes corrections to technical errors and typos throughout the final rule.
Effective date: This document is effective June 2, 2021.
HCPCS Codes Subject to and Excluded from CLIA Edits
On June 2, CMS published Medicare Claims Processing Transmittal 10831, which rescinds and replaces Transmittal 10613, dated March 10, 2021, to revise sections of the background related to the QW modifier and to revise business requirement 12131.2, which is also related to the QW modifier. The original transmittal was issued regarding new HCPCS codes for 2021 that are subject to and excluded from CLIA edits.
CMS revised MLN Matters 12131 on the same date to accompany the transmittal.
Effective date: April 1, 2021
Implementation date: April 5, 2021
ICD-10 and Other Coding Revisions to NCDs--July 2021
On June 2, CMS published One-Time Notification Transmittal 10832, which rescinds and replaces Transmittal 10804, dated May 17, 2021, to revise business requirement 12124.2.1, replace the attached spreadsheet for NCD 90.2, Next Generation Sequencing, associated with BR 2, and remove BR 8 and associated spreadsheet titled NCD 230.9, Cryosurgery of Prostate. The original transmittal was issued regarding the regular ICD-10 conversions and coding updates specific to NCDs.
CMS revised MLN Matters 12124 on the same date to accompany the transmittal.
Effective date: July 1, 2021 - Unless otherwise indicated in business requirements
Implementation date: July 6, 2021
MACs Resume Medical Review on a Post-Payment Basis
On June 3, CMS published a Note in MLN Connects regarding the resumption of post-payment medical reviews. Beginning in August 2020, MACs resumed post-payment reviews for dates of service before March 2020. This new announcement states MACs may now begin conducting post-payment medical reviews for later dates of service. The Targeted Probe and Educate program will restart at a later date.
University of Michigan Health System: Audit of Medicare Payments for Polysomnography Services
On June 4, the OIG published a Review of whether claims the University of Michigan Health System submitted to Medicare for polysomnography services complied with Medicare requirements. The audit reviewed lines of polysomnography services billed using CPT codes 95810 and 95811. The OIG found that University of Michigan did not meet requirements for four of the 100 beneficiaries reviewed and five of the 165 lines of services for those beneficiaries. The OIG found four lines of service that had incomplete medical record documentation and one line of service that was incorrectly coded. It estimated that, on the basis of the sample, University of Michigan received overpayments of at least $12,520 during the audit period for these services.
The OIG recommends University of Michigan refund Medicare the estimated $12,520 in overpayments, return any similar overpayments in accordance with the 60-day rule, and implement policies and procedures to ensure that Medicare claims for these services comply with Medicare polysomnography requirements. The University of Michigan disagreed with the findings pertaining to incomplete medical record documentation, but the OIG maintained its findings and explained what problems it identified in the University of Michigan’s documentation.
Comment Request: Request for Certification in the Medicare/Medicaid Program for Providers of Outpatient Physical Therapy and/or Speech-Language Pathology
On June 4, CMS published a Comment Request in the Federal Register regarding an information collection titled, “Request for Certification in the Medicare/Medicaid Program for Providers of Outpatient Physical Therapy and/or Speech-Language Pathology.”
Comments are due by August 3.