This week in Medicare updates—8/21/2019
Medicare Provider-Supplier Enrollment National Educational Products
On August 12, CMS published an MLN Resource regarding educational resources on enrollment for Medicare providers and suppliers. The resource includes a three-page table listing available educational items and an overview of the information contained in each.
Comparison of Average Sales Prices (ASP) and Average Manufacturer Prices: Results for the First Quarter of 2019
On August 13, the OIG published a Report regarding drugs for which the ASP exceeds the AMP by 5% or more for two consecutive quarters or three of the previous four quarters. When this happens, CMS substitutes 103% of the AMP for the ASP-based reimbursement. In the first quarter of 2019, 11 drug codes met this price substitution criteria. The OIG will provide these results to CMS for review.
NCA Tracking Sheet for Transcatheter Mitral Valve Repair (TMVR)
On August 14, CMS published a Tracking Sheet regarding an NCA for TMVR. This analysis will focus on utilizing TMVR for treatment of significant symptomatic functional mitral regurgitation and will review the NCD’s requirement for randomized controlled trials of non-FDA approved indications. It will also consider revising the title of the NCD to Transcatheter Mitral Valve Interventions to allow CMS to consider future potential coverage pathways for other transcatheter mitral valve treatments.
The tracking sheet initiates a 30-day public comment period which ends on September 13, 2019.
Updated OIG Work Plan
On August 15, the OIG updated its Work Plan with the following new items:
- Medicare Payments of Positive Airway Pressure Devices for Obstructive Sleep Apnea Without Conducting a Prior Sleep Study
- Review of the Medicare DRG Window Policy
- Medicare Market Shares for Diabetic Testing Strips from April to June 2019
- Nursing Homes: CMS Oversight of State Survey Agencies
- Medicare Part B Services to Medicare Beneficiaries Residing in Nursing Homes During Non-Part A Stays
- Review of Medicare Facet Joint Procedures
Inpatient Rehabilitation Facility (IRF) Annual Update: Prospective Payment System (PPS) Pricer Changes for FY 2020
On August 15, CMS published Medicare Claims Processing Transmittal 4368, which rescinds and replaces Transmittal 4353, dated August 2, 2019, to replace the Health Insurance Prospective Payment System (HIPPS) Case Mix Group (CMG) Codes spreadsheet with a corrected version. The original transmittal was issued regarding the annual update of the IRF Pricer software package. The updates include several rate changes and will utilize case-mix groups as established in the IRF PPS final rule.
On August 16, CMS published a revised MLN Matters 11345 to accompany the transmittal.
Effective date: October 1, 2019
Implementation date: October 7, 2019
Quarterly HCPCS Drug/Biological Codes Changes - October 2019 Update
On August 16, CMS published Medicare Claims Processing Transmittal 4367 regarding updates to drug and biological HCPCS codes for October. The update includes 44 new codes, two discontinuations, and seven modifications.
Effective date: October 1, 2019
Implementation date: October 7, 2019
Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - October 2019 Update
On August 16, CMS published Medicare Claims Processing Transmittal 4362 regarding the October updates to the MPFSDB. These include changes to RVUs for codes 96931 and 96934, updates to several J and Q codes, and a new short descriptor for Q5115 (Inj truxima 10 mg).
CMS published MLN Matters 11402 on the same date to accompany the transmittal.
Effective date: January 1, 2019
Implementation date: October 7, 2019
Update to Hospice Payment Rates, Hospice Cap, Hospice Wage Index, and Hospice Pricer for FY 2020
On August 16, CMS published Medicare Claims Processing Transmittal 4363 regarding updates to hospice payment rates, wage index, and pricer for 2020. It also updates the FY 2020 hospice aggregate cap amount, which is $29,964.78 in 2020.
Effective date: October 1, 2019
Implementation date: October 7, 2019