This week in Medicare updates—9/19/2018
Merit-based Incentive Payment System (MIPS) 2018 Assignment Methodology Specifications for the CMS Web Interface and CAHPS for MIPS Survey
On September 10, CMS published a Report to describe the process for assigning beneficiaries to a group or virtual group participating in MIPS. The report contains information on the Medicare data used to assign beneficiaries to groups and information on assignment criteria for a variety of provider types.
ICD-10 and Other Coding Revisions to National Coverage Determinations (NCD)
On September 11, CMS published One-Time Notification Transmittal 2138, which rescinds and replaces Transmittal 2122, dated August 10, 2018, to remove ICD-10 diagnosis code H25.13 from the NCD80.11 spreadsheet that was retained in error. The original transmittal was issued regarding the maintenance update of ICD-10 conversions and other coding updates specific to NCDs.
CMS published a revised MLN Matters 10859 on September 12 to accompany the transmittal.
Effective date: January 1, 2019, unless otherwise noted in requirements
Implementation date: January 7, 2019, for shared system edits; September 28, 2018, for local MAC edits
Intensity-Modulated Radiation Therapy (IMRT) Planning Services Editing
On September 11, CMS published Special Edition MLN Matters 18013 regarding billing procedures for outpatient IMRT claims. Medicare pays hospitals under the OPPS a bundled payment for the planning phase of these services regardless of when they are billed. The article comes after a recent OIG report found that 100% of the claims reviewed in an OIG audit incorrectly billed for IMRT services.
Effective date: N/A
Implementation date: N/A
CMS Offers Broad Support for North Carolina and South Carolina with Hurricane Florence Preparation
On September 13, CMS published a Press Release regarding assistance for South Carolina and North Carolina in the wake of Hurricane Florence. In response to public health emergencies that were declared in both states, CMS has waived certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements; created special enrollment opportunities for hurricane victims to ensure continued access to health coverage; and activated certain provisions to assist dialysis patients in obtaining services. CMS also encouraged those impacted by the hurricane to seek help by visiting CMS’ emergency webpage.
Quarterly HCPCS Drug/Biological Code Changes - October 2018 Update
On September 13, CMS published Medicare Claims Processing Transmittal 4134 which rescinds and replaces Transmittal 4114, dated August 10, 2018, to add new HCPCS code Q5110 (injection, filgrastim-aafi, biosimilar, [nivestym], 1 microgram), updated BR 10834.5, and added BRs 10834.6-10834.8. The original transmittal was published to provide the regular quarterly updates to the HCPCS code set.
CMS published a revised MLN Matters 10834 on the same date to accompany the transmittal.
Effective date: For Q5108, effective date is July 12, 2018, and for Q5110, effective date is October 1, 2018
Implementation date: October 1, 2018
Manual Updates Related to Payment Policy Changes Affecting the Hospice Aggregate Cap Calculation and the Designation of Hospice Attending Physicians
On September 14, CMS published Medicare Benefit Policy Transmittal 246 regarding updates to the Internet Only Manual stemming from recent legislation. These updates include recognizing physician assistants as designated hospice attending physicians, in addition to physicians and nurse practitioners (effective January 1, 2019). The updates also include updating policies related to the calculation methodology for the cap amount for hospices and updates to policies regarding timeframe and accounting procedures for the cap amount for hospices.
Update to the Medicare Claims Processing Manual, Chapter 23, Section 60.3
On September 14, CMS published Medicare Claims Processing Transmittal 4130 regarding changes to the Internet Only Manual which will update to methodology for gap-filling DMEPOS fee schedules to reflect new sources of gap-fill pricing information.
CMS published MLN Matters 10924 on the same date to accompany the transmittal.
Effective date: June 11, 2018
Implementation date: October 15, 2018