This week in Medicare updates—7/18/2018

Transition to New Medicare Numbers and Cards

On July 10, CMS published a Fact Sheet regarding the new Medicare numbers and cards. The fact sheet contains detailed information about the structure of the Medicare Beneficiary Identifier (MBI) numbers, how facilities can prepare for and use new MBIs, and when to expect future waves of card mailings.

 

Medicare Improperly Paid Providers for Items and Services Ordered by Chiropractors

On July 10, the OIG published a Review of a study it conducted to determine whether Medicare payments for selected items and services ordered by chiropractors complied with Federal requirements, as Medicare only covers chiropractic services in the form of treatment through manual manipulation. The OIG found that, from calendar years 2013 through 2016, Medicare improperly paid providers $6.7 million because CMS’s claims processing edits were not fully effective in preventing overpayments. CMS began using these edits on October 5, 2009, but it did not utilize the edits to deny claims until January 6, 2014. As a result, 89% of the improper payments ($5.9 million) were for items and services provided before that January 2014 implementation.

The OIG recommends CMS recover the portion of the $6.7 million in overpayments within the reopening period and instruct Medicare contractors to notify providers of potential overpayments so providers can investigate and return any similar overpayments. The OIG also recommends CMS revise the claims processing edits to ensure that items and services ordered by chiropractors are denied.

 

2018 MIPS Fact Sheets

On July 11, CMS published a Fact Sheet regarding the 2018 requirements for Merit-based Incentive Payment System (MIPS) participation and reviewed the details of the overall MIPS program. The fact sheet is divided into three sections to explain participation, policy highlights, and to compare the 2018 policies to the 2017 policies.  

Also on July 11, CMS published a Fact Sheet regarding the available bonus points available in the Merit-based Incentive Payment System (MIPS) in 2018. Bonus points are available in the Quality performance category, Promoting Interoperability performance category, and final score. The fact sheet discusses what participants must do to qualify for bonuses and how the bonus point system will work.

 

End-Stage Renal Disease and Durable Medical Equipment, Payment Systems Proposed Rule 

On July 11, CMS published a display copy of the End-Stage Renal Disease (ESRD) and Durable Medical Equipment Proposed Rule. The full version will be published in the Federal Register on July 19, 2018. The proposed rule includes changes to the bidding and pricing methodologies under the DMEPOS CBP, the expansion of the transitional drug add-on payment adjustment (TDAPA) for the ESRD prospective payment system, updates to the acute kidney injury dialysis payment rate, and more.

CMS published a Press Release and Fact Sheet on the same date to accompany the proposed rule. Comments on the proposed rule are due no later than 5 p.m. on September 10, 2018.

 

The Medicare Advantage Qualifying Payment Arrangement Incentive Demonstration

On July 12, CMS issued a Fact Sheet regarding the Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) demonstration, which would test whether exempting Merit-based Incentive Payment System (MIPS)-eligible clinicians from MIPS if they participate in certain payment arrangements with Medicare Advantage organizations would increase or maintain participation in payment arrangements that are similar to the Advanced APMs. The fact sheet explains the eligibility for the demonstration, the application process and participation, the qualifying payment arrangement, and the submission process for demonstration waivers.

 

Proposed Rule for the Quality Payment Program

On July 12, CMS published a Fact Sheet regarding the Quality Payment Program Year 3 Proposed Rule, which was published as part of the Medicare Physician Fee Schedule Notice of Proposed Rulemaking on the same date. The fact sheet provides an overview of the proposals for Year 3 of the program, which include:

• Applying MIPS payment adjustments to covered professional services under the physician fee schedule rather than all items and services under Medicare Part B as mandated by the Bipartisan Budget Act of 2018
• Allowing clinicians or groups to opt-in to MIPS if they meet or exceed some but not all of the low-volume threshold criterion
• Changing the payment category weights for the final MIPS score
• Implementing a new scoring methodology for the Promoting Interoperability performance category

Comments on the proposals are due no later than 5 p.m. on September 10, 2018.

 

CY 2019 Medicare Physician Fee Schedule (PFS) Proposed Rule

On July 12, CMS published a display copy of the CY 2019 Medicare Physician Fee Schedule Notice of Proposed Rulemaking, which will be published in the Federal Register on July 27, 2018. One of the most significant proposals includes a complete overhaul of the documentation standards and payment rates for evaluation and management (E/M) codes to streamline payment for new and established patients for office/outpatient E/M levels 2 through 5 visits. CMS also proposes allowing providers to choose whether to use medical-decision making or time to document E/M visits instead of following the 1995 or 1997 documentation guidelines. Other significant proposals in the PFS proposed rule include:

• Changing wholesale acquisition cost (WAC)-based payments from plus-6% to plus-3%
• Keeping the PFS relativity adjuster at 40% for non-excepted off-campus provider-based hospital departments
• Expanded reporting and payment options for virtual care
• Discontinuing functional status reporting requirements for outpatient therapy and establishing new modifiers for services provided by PT and OT assistants

CMS published a Press Release and Fact Sheet on the same date to accompany the proposed rule. Comments are due to CMS by no later than 5 p.m. on September 10, 2018.

 

Medicare Quarterly Provider Compliance Newsletter

On July 13, CMS published the Medicare Quarterly Provider Compliance Newsletter, which addresses common billing errors and other non-compliant activities in the fee-for-service program. This edition of the newsletter addresses Comprehensive Error Rate Testing (CERT) and Recovery Auditor findings including:

• Insufficient documentation causing improper payments for surgical dressings
• A reminder about Medicare coverage for vagus nerve stimulation
• Improper billing for more than one unit of cataract removal on the same date of service
• Improper unbundling of blood glucose monitor supplies
• Insufficient documentation to prove medical necessity of skilled nursing facility care

 

Comment Request: Transcatheter Mitral Valve Repair (TMVR) National Coverage Decision (NCD); Conditions of Coverage for Portable X-ray Suppliers and Supporting Regulations; and more

On July 13, CMS published a Comment Request in the Federal Register regarding the following information collections:

• Transcatheter Mitral Valve Repair (TMVR) National Coverage Decision (NCD)
• Conditions of Coverage for Portable X-ray Suppliers and Supporting Regulations
• National Implementation of the Hospital CAHPS Survey
• State Data for the Medicare Modernization Act (MMA)
• Part C Medicare Advantage Reporting Requirements and Supporting Regulations in 42 CFR 422.516(a)
• Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery (OAS CAHPS) Survey
• Medicare Enrollment Application for Physician and Non-Physician Practitioners

Comments on these information collections are due to the OMB desk officer by August 13, 2018.

 

New Physician Specialty Code for Undersea and Hyperbaric Medicine

On July 13, CMS published Medicare Financial Management Transmittal 306 and Medicare Claims Processing Transmittal 4087 regarding a new physician specialty code for Undersea and Hyperbaric Medicine (D4). The transmittals also provide instructions for including supplier specialty code for the Medicare Diabetes Prevention Program (D1) and Restricted Use (D2) in submissions for CROWD Form “F” (Participating Physician/Supplier Report).

Effective date: January 1, 2019

Implementation date: January 7, 2019

 

Medical Review of Evaluation and Management (E/M) Documentation

On July 13, CMS published Medicare Program Integrity Transmittal 808 to establish a new section in Chapter 6 of the Medicare Program Integrity Manual to provide directions to medical review contractors on how to review claims where a medical student documented the E/M service. This transmittal follows instructions from CR 10412, which allowed teaching physicians to verify students’ E/M visit notes instead of re-documenting them.

Effective date: August 14, 2018

Implementation date: August 14, 2018