This week in Medicare updates—9/11/2019
Revised Rural Health Clinic (RHC) Guidance Updating Emergency Medicine Availability—State Operations Manual (SOM) Appendix G- Advanced Copy
On September 3, CMS published a Memorandum to state survey agency directors regarding revisions to Appendix G of the SOM to update medical guidance as it pertains to the availability of drugs and biologicals commonly used in life-saving procedures. RHCs are instructed to consider each of the categories of drugs/biologicals to store for use in treating common life-threatening injuries/acute illnesses, but they are not required to store all of them. Clinics should have written policies and procedures for determining which drugs/biologicals are stored as well as the process for determining which to store.
Effective date: Immediately. This guidance should be communicated with all survey and certification staff, their managers, and the state/regional office training coordinators within 30 days of this memorandum.
CMS Offers Broad Support for Georgia and the Carolinas with Hurricane Dorian Preparation
On September 3 and 4, CMS published separate press releases on actions it is taking to support Hurricane Dorian recovery efforts in North Carolina, South Carolina, and Georgia. These actions include temporary waivers for certain Medicare requirements, special enrollment opportunities to allow for immediate access to healthcare, steps to ensure dialysis patients can obtain services, and more.
On September 3, 4, and 5, CMS published a series of Special Edition MLN Matters articles to provide information on the blanket waivers, extensions, and DMEPOS/prescription replacements granted through Medicare to areas in Florida, North Carolina, South Carolina, and Georgia affected by the hurricane.
For more information on CMS activities related to tropical storm/hurricane relief, visit CMS’ emergency website.
Updates to Civil Money Penalty (CMP) Reinvestment Resource Materials
On September 4, CMS published a Memorandum to state survey agency directors regarding numerous updates to CMP reinvestment resources. These updates include changes to the example CMP reinvestment application template, updates to the CMP reinvestment state plan resources to create 2020 versions that will replace the 2019 versions, revisions to the state CMP reinvestment projects funded in CY 2017 to account for additional reported results, and more.
Effective date: Immediately. This guidance should be communicated with all survey and certification staff, their managers, and the state/regional office training coordinators within 30 days of this memorandum.
Final Rule: Program Integrity Enhancements to the Provider Enrollment Process
On September 5, CMS published a draft version of a Final Rule with Comment regarding changes to the provider enrollment process for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). The rule aims to prevent fraud before it happens by tightening restrictions on enrollment for providers and suppliers who may have current or previous affiliations with previously sanctioned entities, and it allows CMS to revoke enrollment for those with problematic affiliations. The rule also provides administrative authority to revoke or deny enrollment for those who bill for items and services from non-compliant locations, have outstanding debts owed to CMS from overpayments referred to the Treasury department, attempt to circumvent rules by returning to Medicare/Medicaid/CHIP under a different name, and more.
Comments on the rule are due by November 4, 2019. The rule is scheduled to be published in the Federal Register on September 10. CMS published a Press Release on the rule on September 5.
Effective date: November 4, 2019
Medicare Part B Clinical Laboratory Fee Schedule: Revised Information for Laboratories on Collecting and Reporting Data for the Private Payor Rate-Based Payment System
On September 5, CMS published a revised version of Special Edition MLN Matters 19006, dated February 27, 2019, to delete incorrect information in the section titled Only Applicable Information Attributed to non-Hospital Patients is Reported. The original article was issued regarding ways laboratories can meet the requirements under Section 1834A of the Social Security Act for the Medicare Part B Clinical Laboratory Fee Schedule (CLFS).
Activation of Systematic Validation Edits for OPPS Providers with Multiple Service Locations
On September 5, CMS published a revised version of Special Edition MLN Matters 19007, dated March 26, 2019, to announce a delay of full implementation until April 2020. The original article was issued regarding the activation of systematic validation edits relevant to providers with multiple service locations.
Updated Corporate Integrity Agreement Documents
On September 5, the OIG published information on a new Corporate Integrity Agreement with ACell, Inc., of Ashland, KY. It also announced closed cases with the following entities:
- Florida Pain Medicine Associates, Inc.; Gatz, M.D., Bart; Renta, M.D., Alexis; Rodriguez, M.D., Albert, of Boynton Beach, FL
- Trans-Star Ambulance Service, of Prestonsburg, KY
- Sound Inpatient Physicians, Inc. and affiliates, of Tacoma, WA
Oceanside Medical Group Received Unallowable Medicare Payments for Psychotherapy Services
On September 5, the OIG published a Review of whether Oceanside Medical Group complied with Medicare requirements when billing for psychotherapy services. The OIG found that none of the 100 sampled beneficiary days (consisting of 103 psychotherapy services) complied with Medicare requirements. Because Oceanside did not have policies or procedures in place that ensured psychotherapy services billed to Medicare were actually provided, adequately documented, and correctly billed, the OIG determined that 52 services did not have sufficient evidence that psychotherapy was provided, 49 services did not properly document time, and two services did not have adequate supporting documentation. This resulted in $5,317 in unallowable Medicare payments for the sample and an estimated $2.6 million in unallowable Medicare payments overall for psychotherapy services.
The OIG recommends Oceanside refund Medicare for claims that are within the reopening period, exercise reasonable diligence to identify and return overpayments in accordance with the 60-day rule outside of both the reopening period and audit period, and implement policies and procedures to strengthen management oversight to ensure that psychotherapy services billed to Medicare are provided, adequately documented, and correctly billed. Oceanside disagreed with the OIG’s findings, mostly because Oceanside claimed its style of documentation for these services were sufficient, but after considering Oceanside’s comments, the OIG maintained its original findings.
Updated List of Excluded Individuals and Entities (LEIE)
On September 6, the OIG updated its LEIE with an updated LEIE database for download and lists of August 2019 exclusions, reinstatements, and profile corrections.
Comment Request: Health Reimbursement Arrangements and Other Account-Based Group Health Plans
On September 6, CMS published a Comment Request in the Federal Register regarding an information collection titled, “Health Reimbursement Arrangements and Other Account-Based Group Health Plans.” Comments are due by November 5, 2019.
Revisions to State Operations Manual (SOM), Appendix Q
On September 6, CMS published State Operations Provider Certification Transmittal 192 regarding revisions made to Appendix Q of the SOM to reinsert language about referring criminal acts to law enforcement.
Effective date: September 6, 2019
Implementation date: September 6, 2019
Updates to Provider Enrollment Processing Instructions in Chapter 15 of Program Integrity Manual and to CMS-855R Processing Guide
On September 6, CMS published Medicare Program Integrity Transmittal 898 regarding updates to information for provider enrollment, including various processing alternatives for each Form CMS-855 application, Form CMS-20134, and Form CMS-588. Updates also include allowing lockboxes to serve as special payment addresses (under certain conditions), information regarding independent diagnostic testing facility equipment and ownership changes, enrollment procedures for changes involving interpreting physicians, and more.
Effective date: October 7, 2019
Implementation date: October 7, 2019
Implementation of the Award for the Jurisdiction H Part A and Part B MAC
On September 6, CMS published One-Time Notification Transmittal 2358 regarding the award for the JH A/B MAC workload to Novitas, the incumbent contractor for the workload. It will not be changing the current JH workload identifier numbers or business segment identifiers.
Effective date: September 30, 2019
Implementation date: September 30, 2019
October 2019 Update of the Ambulatory Surgical Center (ASC) Payment System
On September 6, CMS published Medicare Claims Processing Transmittal 4389 regarding the October update of the ASC payment system. Changes include 20 new HCPCS codes for separately payable drugs and biologicals, one status indicator change for the April 1, 2019 through June 30, 2019 period, one status indicator change for the July 18, 2019 through September 30, 2019 period, and more.
Effective date: October 1, 2019
Implementation date: October 7, 2019
Additional Instructions to Hospitals on the Election of a Medicare-Supplemental Security Income (SSI) Component of the Disproportionate Share (DSH) Payment Adjustment for Certain Cost Reports
On September 6, CMS published One-Time Notification Transmittal 2357 regarding additional instructions applicable for hospital cost reporting periods that involve SSI ratios for FY 2004 and earlier, or SSI ratios for hospital realignment requests to use its cost reporting period for those patient discharges occurring before October 1, 2004.
Effective date: December 9, 2019
Implementation date: December 9, 2019