This week in Medicare updates—7/3/19

July 3, 2019
Medicare Insider

Billing and Payment Policy Clarification for Negative Pressure Wound Therapy Using a Disposable Device

On June 11, CMS published a revised Special Edition MLN Matters 17027 to clarify the description for coding the TOT UNIT/COV UNIT field on Type of Bill 34x on page 6 of the article to indicate that home health agencies (HHA) should report 1 in that field. The original article was issued to discuss a policy that was effective January 1, 2017, in which Medicare pays a separate amount for a disposable Negative Pressure Wound Therapy device for a patient under a home health plan of care.


Final Decision Memo for Transcatheter Aortic Valve Replacement (TAVR)

On June 21, CMS published a Final Decision Memo regarding updates to coverage for TAVR procedures. CMS previously covered TAVR procedures under Coverage with Evidence Development (CED) when furnished according to FDA-approved indications. The updates are to the volume requirements for hospitals and physicians to begin or maintain a TAVR program.

CMS published a Press Release on the same date to announce the new coverage policy.    


Executive Order on Improving Price and Quality Transparency

On June 24, President Trump issued an Executive Order on increased price transparency requirements. The order instructs HHS to propose a regulation within 60 days of the order to require hospitals to publicly post standard charge information in consumer-friendly formats. It also instructs the secretaries of HHS, Treasury, and Labor to issue an advance notice of proposed rule-making to solicit comments on a proposal to make providers, insurance issuers, and self-insured group health plans to provide access to information about expected out-of-pocket costs for items and services to a patient prior to providing care. The order also contains requirements regarding data for researchers, innovators, and providers to help develop tools that can help better inform patients on the costs of healthcare goods and services. 

CMS Administrator Seema Verma issued a Statement on the same date applauding the Executive Order.   



Interaction of the Emergency Medical Treatment and Labor Act (EMTALA) and the Born-Alive Infants Protection Act of 2002

On June 27, CMS reissued a Memorandum to state survey agency directors to remind hospitals of their obligation to comply with EMTALA as it relates to the Born-Alive Infant Protection Act of 2002. The original policy is not new. The act adds to the definition of “individual” to include every infant born alive at any stage of development and includes a definition of the term “born alive” as any species of homo sapien extracted or expelled from the mother who has a beating heart, pulsation of the umbilical cord, or definite movement of voluntary muscles. EMTALA applies to these infants. CMS added a note to the original memo to state that The Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015 sets civil monetary penalties annually for EMTALA enforcement actions.

CMS published Special Edition MLN Matters 19012 on the same date to further explain the compliance requirements related to EMTALA and the Born Alive Act. 


Pre-Diabetes Services: Referring Patients to the Medicare Diabetes Prevention Program

On June 27, CMS published Special Edition MLN Matters 19001 regarding education for providers who may refer patients to the Medicare Diabetes Prevention Program (MDPP) for services to reduce diabetes risk. The article provides background on the program, requirements to start MDPP services, ways to find MDPP suppliers, and details on provider roles in the MDPP referral process. 


Next Generation ACO Model - Demo Code Placement


On June 28, CMS published Demonstrations Transmittal 227 regarding an issue for Next Generation ACO (NGACO) claims that was preventing the application of two demo codes on claims. The transmittal instructs the shared system maintainer (SSM) to apply NGACO demo code 74 to claims that already have demo codes on the claim record and to apply code 74 to position 1 on claims that already have demo code 86 (BPCI Advanced) in certain circumstances. 

Effective date: October 1, 2019

Implementation date: October 7, 2019


Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Pricer Update FY 2020

On June 28, CMS published Medicare Claims Processing Transmittal 4325 regarding updates to payment rates used under the SNF PPS for 2020. 

Effective date: October 1, 2019

Implementation date: October 7, 2019