This week in Medicare updates—8/1/2018

August 1, 2018
Medicare Insider

Promoting Interoperability (PI) Hardship Exceptions FAQ

On July 20, CMS published an FAQ regarding hardship exceptions for the Promoting Interoperability performance category of the Merit-based Incentive Payment System (MIPS) in 2018. The FAQ also discusses questions about CMS’ Extreme and Uncontrollable Circumstances policy and how providers impacted by such circumstances should manage MIPS reporting in 2018.


Video: CMS Panel Discussion on E/M Coding Reform

On July 20, CMS posted a Video to its YouTube channel of a panel discussion it held on the proposed changes to E/M coding and documentation from the Physician Fee Schedule proposed rule. The discussion was held to help providers understand what CMS plans to do regarding E/M codes so that providers can send appropriate and meaningful feedback to CMS during the 60-day comment period for the rule.  


2019 Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment Systems Proposed Rule

On July 25, CMS issued a display copy of the 2019 OPPS Proposed Rule, which will be published in the Federal Register on July 31. The rule contains several proposals aimed at enforcing site-neutral payments and reducing drug payments. Some of these proposals include:

  • Applying the Physician Fee Schedule (PFS)-equivalent payment rate to outpatient clinic visits provided at an off-campus provider-based department (PBD) paid under the OPPS, which would reduce the payment rate for the visit from approximately $116 to approximately $46
  • Expanding the average sales price (ASP) minus 22.5% payment rate for drugs acquired through the 340B drug discount program to those 340B drugs furnished in non-excepted off-campus PBDs
  • Changing payment for services in new clinical families of services furnished at excepted off-campus PBDs to payment under the PFS instead of the OPPS, which would set payment for those services at 40% of the OPPS rate

CMS is including requests for information in the proposed rule on promoting interoperability and electronic health care information exchanges, improving beneficiary access to provider and supplier charge information, and leveraging the authority for the Competitive Acquisition Program (CAP) for Part B drugs and biologicals for a potential CMS Innovation Center model.

CMS issued a Press Release and Fact Sheet on the proposed rule on the same date. Comments on the rule are due no later than 5 p.m. ET on September 24, 2018.


Updated Stipulated Penalties and Exclusion for Material Breach

On July 25, the OIG updated its list of Stipulated Penalties and Exclusion for Material Breaches with one new action:

  • On July 18, eClinical Works, LLC, paid a stipulated penalty of $132,500 due to a failure to comply with its obligation to timely report patient safety issues as reportable events


Patients Over Paperwork July Newsletter

On July 26, CMS published the July edition of its Patients Over Paperwork newsletter. This edition of the newsletter discusses ways CMS is attempting to reduce burden for skilled nursing facilities and highlights ways to provide feedback to CMS on a variety of topics, such as the Physician Fee Schedule, Stark Law, and various payment system proposed rules.


Clarify Detailed Written Orders for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)

On July 27, CMS published Medicare Program Integrity Transmittal 812, which rescinds and replaces Transmittal 806, dated July 6, 2018, to delay the effective/implementation date by three weeks, clarify the requisite detailed written orders date, more closely align the language regarding the physician’s “completion” of the order for Power Mobility Devices to the regulation by updating the manual, and highlight the purpose of removing the word “received” in the background section. The original transmittal was issued to clarify the instructions for conducting medical reviews of written orders provided for most items of DMEPOS.

Effective date: August 28, 2018

Implementation date: August 28, 2018