This week in Medicare updates—8/14/2019

August 14, 2019
Medicare Insider

MLN Critical Access Hospital Booklet

On August 5, CMS published an MLN Booklet to provide information regarding critical access hospital requirements, payments, and grant programs. The booklet also contains a table with links to additional information on billing, survey and certification processes, and swing bed requirements as well as a table with links to statutory requirements for CAHs.


MLN Chronic Care Management Services Booklet   

On August 5, CMS published an MLN Booklet to provide information on separately payable services for beneficiaries with multiple chronic conditions, physician fee schedule billing requirements for chronic care management services, practitioner and patient eligibility, and chronic care management service elements.


2020 ICD-10-CM Guidelines for Coding and Reporting

On August 5, the CDC published the 2020 ICD-10-CM Guidelines for Coding and Reporting. There are minor changes to the guidelines for 2020, including new instructions on coding pressure-induced deep tissue damage, iatrogenic injuries, physeal fractures; an update to language in some places to refer to providers instead of physicians; an instruction for coding adverse effects/poisoning/underdosing of multiple unspecified drugs; and more. 

Effective date: October 1, 2019 - September 30, 2020


Decision Memo for Chimeric Antigen Receptor (CAR) T-cell Therapy for Cancers

On August 7, CMS published a Decision Memo regarding an NCD covering CAR T-cell therapy. CMS will cover CAR-T nationwide when administered at healthcare facilities enrolled in the FDA risk evaluation and mitigation strategies (REMS). It will also cover CAR-T when it is used for either an FDA-approved indication or for other uses if it has been FDA-approved and the use is supported in one or more CMS-approved compendia. Routine costs in clinical trials using CAR-T as an investigational agent that meets the requirements in the clinical trials policy will be covered.  

CMS published a Press Release on the NCD on the same date. 


Critical Access Hospitals Adding a Provider-Based Location

On August 8, CMS published a Memorandum to state survey agency directors regarding updates to Chapter 2 of the State Operations Manual with guidance for CAHs adding a provider-based location. The memorandum includes information on documentation CAHs should submit with provider-enrollment applications for provider-based locations and the text of the lengthy change to section 2256H (Off-Campus CAH Facilities) in Chapter 2 of the SOM.

Effective date: Immediately. This policy should be communicated with all survey and certification staff, their managers, and the state/regional office training coordinators within 30 days of this memorandum. 


Updated List of Excluded Individuals and Entities (LEIE)

On August 8, the OIG updated its LEIE with an updated LEIE database for download and lists of July 2019 exclusions, reinstatements, and profile corrections.


Updated Corporate Integrity Agreement Documents

On August 9, the OIG published information on a new Corporate Integrity Agreement with ACell, Inc., of Columbia, MD. It also announced closed cases with the following entities: 

  • Calloway Laboratories, Inc., of Woburn, MA
  • Northwest Physical Therapy, Inc., and Dan Ibarra, of Roseburg, OR
  • PALMS Medical Transport, LLC, of Byron, GA
  • Medicus Laboratories, LLC, of Dallas, TX


Updated Provider Self-Disclosure Settlements

On August 9, the OIG published an updated List of Provider Self-Disclosure Settlements, including:

  • On July 1, Histopathology Services LLC d/b/a Pathline Emerge, of New Jersey, reached a $310,978.11 settlement agreement with the OIG to resolve allegations that it paid remuneration to physician offices in the form of free medical specimen collection supplies. 
  • On July 12, Mary Washington Hospital, Inc., of Virginia, reached a $50,000 settlement agreement with the OIG to resolve allegations that it paid remuneration to a medical practice by not recouping certain amounts it paid to a physician, through the medical practice, pursuant to a physician recruitment arrangement.
  • On July 18, the City of Jacksonville, Florida reached a $337,601.12 settlement agreement with the OIG to resolve allegations that it submitted claims to federal health care programs for ambulance transportation services provided to beneficiaries without obtaining necessary beneficiary authorization for ambulance transports. 
  • On July 23, Mercy Medical Center, of Ohio, reached a $210,739.53 settlement agreement with the OIG to resolve allegations that it billed for professional services of physician assistants under the supervising physician’s provider number as shared/split when the documentation did not support that designation. 
  • On July 26, United Scripts LTC, LLC, of Missouri, reached a $1,258,146.24 settlement agreement with the OIG to resolve allegations that it submitted unauthorized prior authorization forms to federal health care program payors, which were subsequently relied upon by United Scripts when seeking payment for prescription drug claims. 

The list also included two settlements reached after facilities self-disclosed that they employed individuals they knew or should have known were excluded from participation in federal health care programs. These facilities include: 

  • General Physician, P.C., of New York
  • Garfield Park Behavioral Hospital, of Illinois


ICD-10 and Other Coding Revisions to NCDs - January 2020 Update

On August 9, CMS published One-Time Notification Transmittal 2348 regarding a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. 

Effective date: January 1, 2020 - unless otherwise indicated in requirements

Implementation date: January 6, 2020 - MAC local edits 45 days from issuance of CR


Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) Updates for FY 2020

On August 9, CMS published Medicare Claims Processing Transmittal 4357 regarding changes required as part of the annual IPF PPS update. This includes changes to payment factors and to the pricer. 

Effective date: October 1, 2019

Implementation date: October 7, 2019