This week in Medicare updates—7/25/2018
Comment Request: Health Equity Technical Assistance Monitoring and Tracking
On July 16, CMS published a Comment Request in the Federal Register regarding an information collection titled, “Health Equity Technical Assistance Monitoring and Tracking.”
Comments on the information collection are due to the OMB desk officer by August 15, 2018.
Updated OIG Work Plan
On July 16, the OIG updated its Work Plan with the following new items:
- Review of Outpatient 3-Dimensional Conformal Radiation Therapy Planning Services
- Increased Payments For Transfer Claims With Outliers
- Review of Post-Operative Services Provided in the Global Surgery Period
Comment Request: Subpart D-Private Contracts; Medicare Disproportionate Share Adjustment Procedures and Criteria; more
On July 17, CMS published a Comment Request in the Federal Register regarding the following information collections:
- Eligibility of Drugs, Biologicals, and Radiopharmaceutical Agents for Transitional Pass-Through Status Under the Hospital Outpatient Prospective Payment System (OPPS)
- Subpart D-Private Contracts
- Medicare Disproportionate Share Adjustment Procedures and Criteria
Comments are due by September 17, 2018.
Advisory Opinion 18-06
On July 18, the OIG published an Advisory Opinion regarding an arrangement in which a licensed Medigap policy offeror would contract indirectly with the network hospitals for discounts on the otherwise-applicable Medicare inpatient deductibles for its policyholders and, in turn, would provide a premium credit of $100 off the next renewal premium to policyholders who use a network hospital for an inpatient stay. The requestor asked whether this policy would violate the civil monetary penalty provision prohibiting inducements to beneficiaries and the anti-kickback statute. The OIG determined that while the arrangement could generate prohibited remuneration under the anti-kickback statute, it would not impose administrative sanctions in this specific case because the discounts/premium credits would not affect per-service Medicare payments, the arrangement would be unlikely to increase utilization, the arrangement would not affect competition among hospitals, it would be unlikely to affect professional medical judgment, and the arrangement would operate transparently.
Setting Medicare Payment Rates for Clinical Diagnostic Laboratory Tests: Strategies To Ensure Data Quality
On July 18, the OIG published a Review of CMS’ implementation activities in 2017 related to the new payment system for clinical diagnostic laboratory tests and the new payment rates that took effect on January 1, 2018. The OIG found that the new rates could save an estimated $670 million for the calendar year, and rates for 75% of lab tests decreased in 2018. The OIG also found that CMS performed limited quality-assurance checks and relied instead on labs’ self-certification of their reported data. The OIG concluded that CMS should address challenges from 2017 to ensure data quality in the future and address quality assurance efforts and compliance activities.
Medicare Improperly Paid Providers for Non-Emergency Ambulance Transports to Destinations Not Covered by Medicare
On July 18, the OIG published a Review of whether Medicare payments to providers for non-emergency ambulance transports complied with federal requirements. The OIG found that Medicare made improper payments totaling $8.7 million to providers for non-emergency ambulance transports to destinations not covered by Medicare. The majority of those improperly billed claims were for transports to diagnostic or therapeutic sites that did not originate from skilled nursing facilities. The OIG recommends CMS recover the portion of the improper payments for claim lines that are within the claim reopening period, instruct Medicare contractors to notify providers of potentially improper payments for claim lines outside of the reopening period, direct contractors to review claim lines for these types of payments for services after the audit period, and require nationwide pre-payment edits to ensure that payments to providers for non-emergency ambulance transports comply with federal requirements.
New Waived Tests
On July 20, CMS published Medicare Claims Processing Transmittal 4091 to inform contractors of new CLIA waived tests approved by the FDA. There are 18 newly added waived complexity tests, all of which are listed in the transmittal.
Effective date: October 1, 2018
Implementation date: October 1, 2018
Internet Only Manual (IOM) Update to Publication 100-02, Chapter 11 - End Stage Renal Disease (ESRD), Section 100
On July 20, CMS published Medicare Benefit Policy Transmittal 244 regarding an update to the Medicare Benefit Policy Manual in Chapter 11, section 100 related to acute kidney injury.
Effective date: October 23, 2018
Implementation date: October 23, 2018
October Quarterly Update to 2018 Annual Update of HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement
On July 20, CMS published Medicare Claims Processing Transmittal 4093 regarding an update to the lists of HCPCS codes subject to the CB provision of the SNF Prospective Payment System. These changes will be used to revise CWF edits to allow MACs to make appropriate payments in according with policy for SNF CB.
Effective date: October 1, 2018 - For claims processed on or after October 1, 2018 for claims with dates of service on or after January 1, 2016
Implementation date: October 1, 2018
Changes to the Laboratory National Coverage Determination (NCD) Edit Software for October 2018
On July 20, CMS published Medicare Claims Processing Transmittal 4092 to announce changes that will be included in the October 2018 quarterly release of the edit module for clinical diagnostic laboratory services.
Effective date: October 1, 2018
Implementation date: October 1, 2018
Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment
On July 20, CMS published Medicare Claims Processing Transmittal 4090 to provide instructions for the quarterly update of the clinical laboratory fee schedule.
Effective date: October 1, 2018
Implementation date: October 1, 2018
Updated Corporate Integrity Agreement Documents
On July 20, the OIG published information on two new Corporate Integrity Agreements. The new agreements include:
- Healogics, Inc., of Jacksonville, FL
- Health Quest Systems, Inc., Health Quest Medical Practice, P.C., Health Quest Urgent Medical Care Practice, P.C., and Health Quest Home Health Care, Inc., of Lagrangeville, NY
Comment Request: Evaluation of the CMS Quality Improvement Organizations: Medication Safety and Adverse Drug Event Prevention
On July 20, CMS published a Comment Request in the Federal Register regarding an information collection titled, “Evaluation of the CMS Quality Improvement Organizations: Medication Safety and Adverse Drug Event Prevention.”
Comments are due by September 18, 2018.