This week in Medicare updates—7/5/2018
Global Surgical Days for Critical Access Hospital (CAH) Method II
On June 22, CMS issued One-Time Notification Transmittal 2096, which rescinds and replaces Transmittal 2013, dated January 26, 2018, to remove terminated HCPCS codes from business requirement 10425.2.1. The original transmittal was issued to implement the global surgical days for Method II CAH providers.
CMS published a revised MLN Matters 10425 on June 25 to accompany the transmittal.
Effective date: July 1, 2018
Implementation date: July 2, 2018
Advisory Opinion 18-05
On June 25, the OIG published an Advisory Opinion regarding an arrangement in which a hospital’s caregiver center that provides or arranges support services for free or reduced costs to caregivers in the local community. The vast majority of these caregivers are unpaid volunteers who receive training on caring for adults with chronic medical conditions from the center, and the center also serves to support these caregivers by providing resources such as educational sessions, support groups, and some adaptive equipment. The center’s budget is funded by a nonprofit corporation and does not receive funding from any federal healthcare program. The requester inquired as to whether this arrangement would lead to a violation of civil monetary provisions (CMP) prohibiting inducements to beneficiaries or a violation of the federal anti-kickback statute. The OIG determined that, although the arrangement could potentially generate prohibited remuneration under the CMPs, it would not impose sanctions in this specific circumstance for reasons detailed in the advisory opinion.
Beneficiary Notices Initiative Page Redesign
On June 25, CMS published a redesigned Beneficiary Notices Initiative webpage on the CMS website. The webpage now includes a table listing each type of notice, the provider types for whom the notices apply, the purpose of the notice, and the link to download each notice.
2018 CAHPS for MIPS CMS-Approved Survey Vendors
On June 25, CMS published a List of CAHPS for MIPS survey vendors for 2018. Groups that choose to participate in the CAHPS for MIPS survey need to contract with a vendor from the final list of approved 2018 CAHPS for MIPS survey vendors.
Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes - July 2018 Update
On June 26, CMS published Medicare Claims Processing Transmittal 4078, which rescinds and replaces Transmittal 4048, dated May 11, 2018, to add HCPCS codes Q5105 and Q5106 to the background and policy sections and to business requirements 10624.1, 10624.2, 10624.3, and 10624.4. The new transmittal also adds new business requirement 10624.5. The original transmittal was issued regarding the quarterly updates to drug/biological HCPCS codes.
Updated Corporate Integrity Agreement Documents
On June 26, the OIG published information on a new Corporate Integrity Agreement with I&L Express Pharmacy LLC; Irina Minkovich, and Yelena Babchinetskaya, of Holland, PA.
Comprehensive ESRD Care (CEC) Model Telehealth - Implementation
On June 27, CMS published Demonstrations Transmittal 198, which rescinds and replaces Transmittal 196, dated August 27, 2017, to revise the dates in business requirements 10322.214.171.124 and 103126.96.36.199, and to revise the edit code list in business requirements 10314.7.1 and 10314.7.2. The original transmittal was issued regarding the implementation of policy elements for the CEC Model.
On June 28, CMS published a revised MLN Matters 10314 to accompany the transmittal.
Effective date: October 1, 2018
Implementation date: October 1, 2018
Tracking Sheet: Transcatheter Aortic Valve Replacement (TAVR)
On June 27, CMS posted a Tracking Sheet to initiate the national coverage analysis for TAVR. By publishing the tracking sheet, CMS initiates a 30-day public comment period beginning on the posting date and ending on July 27, 2018. CMS said it is particularly interested in comments about clinical studies and other scientific information relevant to the topic.
Toolkit: Using Data Analysis to Calculate Opioid Levels and Identify Patients at Risk of Misuse or Overdose
On June 28, the OIG released a Toolkit for private and public partners, including Medicare Part D plan sponsors, in the administration’s efforts to combat the opioid epidemic. The toolkit helps providers analyze claims data which could aid in identifying patients who may be misusing or abusing prescription opioids and may be in need of additional case management or other follow up.
Opioid Use in Medicare Part D Remains Concerning
On June 28, the OIG published a Data Brief on the extent to which Medicare Part D beneficiaries received extreme amounts of opioids or appeared to be doctor shopping in 2017. It also identifies prescribers who have questionable opioid prescribing. The report states that nearly one in three Part D beneficiaries received a prescription opioid in 2017. While 460,000 beneficiaries received high amounts of opioids in 2017 and approximately 71,000 beneficiaries were estimated to be at serious risk of opioid misuse or overdose in 2017, both of those numbers were lower than they were in 2016. The OIG determined that almost 300 prescribers had questionable opioid prescribing to those 71,000 beneficiaries at serious risk.
CMS Advances Demonstration to Waive MIPS Requirements for Clinicians in Certain At-Risk Medicare Advantage Plans
On June 29, CMS published a Press Release to announce that it is advancing the Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) Demonstration. When approved, this demonstration would waive MIPS requirements for clinicians who have sufficient participation in certain Medicare Advantage plans that involve taking on risk. CMS is seeking public comment on the information collection burdens associated with the demonstration.
CMS Did Not Detect Some Inappropriate Claims for Durable Medical Equipment in Nursing Homes
On June 29, the OIG published a Review of whether a Medicare payment edit intended to reject claims for DME provided during noncovered Skilled Nursing Facilities (SNF) stays and for Medicaid-only nursing facility stays successfully identified inappropriate claims. The OIG found that the Medicare payment edit was not completely successful, as CMS allowed $18.4 million in payments for inappropriate claims for DME provided during noncovered SNF stays, and some SNFs and DME suppliers were able to bypass the CMS edit by not submitting full and accurate claims.
The OIG recommends that CMS strengthen oversight of place-of-service codes, assess the costs/benefits of strengthening oversight of no-payment bills, and assess the costs/benefits of collecting and maintaining information regarding level of care provided by Medicaid-only nursing facilities.
Comment Request: Skilled Nursing Facility and Skilled Nursing Facility Cost Report
On June 29, CMS published a Comment Request in the Federal Register regarding an information collection titled, “Skilled Nursing Facility and Skilled Nursing Facility Cost Report.” Comments on the information collection are due to the OMB desk officer by July 30, 2018.
Comment Request: Medicare Credit Balance Reporting Requirements; Annual Report on Home and Community Based Services Waivers and Supporting Regulations
On June 29, CMS published a Comment Request in the Federal Register regarding the following information collections:
Medicare Credit Balance Reporting Requirements
Annual Report on Home and Community Based Services Waivers and Supporting Regulations
Comments on these information collections are due to the OMB desk officer by July 30, 2018.
Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 24.3 Effective October 1, 2018
On June 29, CMS published Medicare Claims Processing Transmittal 4080 regarding the normal update to the NCCI PTP edits. The latest package of NCCI PTP edits, Version 24.3, will be available via the CMS Virtual Data Center.
CMS published MLN Matters 10827 on the same date to accompany the transmittal.
Effective date: October 1, 2018
Implementation date: October 1, 2018