This week in Medicare updates—9/23/2020
COVID-19 FAQs on Medicare Fee-for-Service Billing
On September 11, CMS updated an FAQ regarding the latest guidance on billing for COVID-19. This round of updates included eight new FAQs in the National Coverage Determinations section (Section CC) on topics such as coverage of infusion drugs at home, ventilator management services provided via telehealth, flexibilities pertaining to face-to-face requirements or direct supervision as applicable to non-COVID-19 patients, and more.
CMS continues to update this document on a regular basis. Providers should review frequently for new information.
CMS Releases Part I of the 2022 Medicare Advantage and Part D Advance Notice
On September 14, CMS published Part I of the 2022 Medicare Advantage and Part D Advance Notice. CMS is publishing this notice earlier than usual to help stakeholders have time to consider the information in light of the uncertainty caused by the COVID-19 PHE. Proposals include fully implementing the 2020 CMS-HCC model in CY 2022 and calculating 2022 risk scores entirely from encounter data.
CMS published a Fact Sheet and Press Release on the same date. Comments are due by 6 p.m. ET on November 13.
Some Manufacturers Reported Inaccurate Drug Product Data to CMS
On September 14, the OIG published a Report on the accuracy of average sales price (ASP) and average manufacturer price (AMP) product data. The OIG found that 24% of all manufacturers reported inaccurate drug product data, and inaccurate ASP or AMP data was reported for 14% of national drug codes (NDC) associated with Part B-covered drugs. Of the 192 drug codes associated with errors found, 151 were associated with inaccurate AMP product data, while 41 were associated with inaccurate ASP data. Eight manufacturers accounted for 60% of all reported errors. The OIG recommends CMS work with manufacturers to update and revise their product data while also taking steps to ensure that future submissions are correct.
Checking Medicare Eligibility
On September 14, CMS published an MLN Fact Sheet on how to check a patient’s Medicare eligibility to ensure proper billing for supplies and services. The fact sheet discusses the MAC Online Provider Portal, MAC IVR System, HETS, and more.
MLN Learning Management System (LMS) FAQs
On September 14, CMS published an MLN Booklet on how to use the LMS, including setting up an account, logging in, resetting passwords, and more.
Comment Request: Medicare Current Beneficiary Survey
On September 14, CMS published a Comment Request in the Federal Register regarding an information collection titled “Medicare Current Beneficiary Survey.” Comments are due by November 16.
Updated OIG Work Plan
On September 15, the OIG updated its Work Plan with the following new item:
CMS Releases CHART Model Notice of Funding Opportunity
On September 15, CMS published a Press Release regarding a Notice of Funding Opportunity for the Community Health Access and Rural Transformation (CHART) Model Community Transformation Track. This track will provide upfront funding to 15 rural communities nationwide to work with healthcare providers and payers in the community to design ways to improve access to high quality care.
Update to the Model Admission Questions for Providers to Ask Medicare Beneficiaries
On September 15, CMS published Medicare Secondary Payer Transmittal 10359, which rescinds and replaces Transmittal 10342, dated September 4, to include the full language in the last sentence in Section 20.2.2 of the IOM, which is currently truncated.
On September 16, CMS revised MLN Matters 11945 to accompany the transmittal.
Effective date: December 7, 2020
Implementation date: December 7, 2020
Home Health Agency Provider Compliance Audit: Mercy Health Visiting Nurse Services
On September 17, the OIG published a Review of whether Mercy Health Visiting Nurse Services complied with Medicare requirements for billing home health services. The OIG found that Mercy billed Medicare incorrectly for 23 of the 100 home health claims reviewed. These issues pertained to services provided to beneficiaries who did not require skilled services or services provided to beneficiaries who were not homebound. The OIG estimated that Mercy received overpayments of at least $1.1 million for the audit period.
The OIG recommends Mercy refund Medicare for the identified overpayments, identify and return any similar overpayments, and follow additional procedural recommendations made in the report. Mercy disagreed with the OIG findings for 21 of the 23 claims identified in the report, as it stated that these claims met Medicare program requirements and were appropriately billed. The OIG maintains that its findings and recommendations are valid.
Final Report: Coronavirus Commission on Safety and Quality in Nursing Homes
On September 16, CMS published a Report from the Coronavirus Commission on Safety and Quality in Nursing Homes about the Commission’s findings and recommendations regarding safety and quality in nursing homes during the COVID-19 PHE. The Commission developed 27 recommendations across 10 themes on areas for improvement, and it identified over 100 actions CMS can take to improve safety and quality in nursing homes. These include immediate development of rapid testing at nursing homes nationwide for COVID-19, federal assistance in ensuring nursing homes can procure and sustain a three-month supply of high-quality PPE, safely increasing controlled and in-person visitation at nursing homes prior to Phase 3 reopening, professionalization of infection prevention positions in nursing homes, and more. The Commission stated that CMS should be able to implement the recommendations in short order and urged CMS to assume a greater leadership role to lead, advocate, and ensure accountability for nursing home residents and staff during the pandemic.
CMS published a Response to the Commission’s report on the same date by detailing actions CMS has taken across all 10 themes. Most actions described by CMS preceded the creation of the Commission. CMS also published a Press Release on the same date.
Nursing Home Visitation - COVID-19
On September 17, CMS published a Memorandum to state survey agency directors regarding new guidance for visitation in nursing homes during the COVID-19. Although previous guidance has focused on protecting residents from COVID-19 and has therefore severely limited or stopped visitation at nursing homes, CMS recognizes that the subsequent isolation also took a severe physical and mental toll on residents. CMS is therefore revising guidance to allow visitation conducted in various ways depending on a facility’s structure and circumstances. Failure to facilitate visitation without a reasonable clinical or safety cause would constitute a potential violation of 42 CFR 483.10(f)(4) and could subject a facility to citation and enforcement actions. The memo also announced that facilities may apply to use civil monetary penalty funds to purchase tents for outdoor visitation and/or clear dividers to create physical barriers. Funding is limited to a maximum of $3000 per facility.
CMS published a Press Release on the memo on the same date.
Effective date: Immediately. This policy should be communicated with all survey and certification staff, their managers, and the state/CMS Locations within 30 days of this memorandum.
Alternative Payment Model (APM) Incentive Payment Advisory for Clinicians--Request for Current Billing Information for Qualifying APM Participants
On September 17, CMS published a Payment Advisory in the Federal Register to alert clinicians who are qualifying APM participants and eligible to receive APM incentive payments that CMS doesn’t currently have the billing information necessary to disburse payment. The advisory provides information for these clinicians on how to update billing information to receive payment.
Dates: This advisory is effective on September 14, 2020.
Privacy Act of 1974
On September 17, CMS published a Notice in the Federal Register regarding a new matching program which is re-establishing the “Do Not Pay Initiative” between CMS and the Department of Treasury, Bureau of Fiscal Service.
Comments on the notice are due by October 19. The program will begin after 30 days of a comment period and will be conducted for an initial term of 36 months. The program can subsequently be renewed.
CMS Offers Comprehensive Support for Oregon due to Wildfires
On September 17, CMS published a Press Release on actions it is taking to support Oregon in response to wildfires across the state. These actions include temporary waivers which will be granted via provider-specific requests through the CMS San Francisco Survey & Enforcement Division, special enrollment opportunities to allow for immediate access to healthcare, steps to ensure dialysis patients can obtain services, and more. CMS’ response to natural disasters has differed from previous years due to the COVID-19 PHE. Providers in impacted areas should review the press release and CMS’ new non-COVID emergency website for more details.
Update to the Implementation of the Increased Payments for COVID-19 Discharges Under the IPPS Under Section 3710 of the CARES Act
On September 17, CMS published One-Time Notification Transmittal 10361, which rescinds and replaces Transmittal 10300, dated August 14, to remove business requirement 11925.6. The transmittal is no longer sensitive and may now be posted to the internet. The original transmittal prospectively updates the implementation of Section 3710 of the CARES Act to require that a patient’s medical record has a positive COVID-19 lab test to be eligible for increased payment for COVID-19 discharges under the IPPS.
Effective date: September 1, 2020
Implementation date: October 5, 2020
Final Rule: Specialty Care Models to Improve Quality of Care and Reduce Expenditures
On September 18, CMS published a draft copy of a Final Rule implementing two new mandatory Medicare payment models: the Radiation Oncology model (RO) and the End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model. The RO model will test whether making prospective payments for radiotherapy episodes of care at hospital outpatient departments and freestanding radiation therapy centers will reduce spending while improving or maintaining the same quality of care. The ETC model will encourage greater use of home dialysis and kidney transplants to preserve or enhance care quality while reducing spending. Both models begin January 1, 2021.
CMS published a Press Release and Fact Sheet on the ETC model, and it published a separate Press Release and Fact Sheet on the RO model.
Pennsylvania Rural Health Model
On September 18, CMS updated a Fact Sheet on the Pennsylvania Rural Health Model (PARHM) to include information on current and eligible participants in light of overlap from other models, such as the Radiation Oncology model.
Medicare-Allowed Charges for Noninvasive Ventilators are Substantially Higher Than Payment Rates of Select Non-Medicare Payers
On September 18, the OIG published a Review of whether Medicare-allowed charges for noninvasive ventilators were comparable with payment rates of select non-Medicare payers. The OIG found that they were not comparable, and Medicare and its beneficiaries could have saved a combined $86.6 million if Medicare-allowed charges were comparable with payment rates of select non-Medicare payers on HCPCS code E0466 (home ventilator, any type, used with non-invasive interface). However, Medicare’s statutorily mandated fee schedule payments do not allow CMS to adjust pricing for noninvasive ventilators, as payments are based on an economic update factor applied annually. CMS adjustments to certain fee schedule amounts for DMEPOS items do not apply to these ventilators.
The OIG recommends CMS review Medicare-allowed charges for HCPCS code E0466 and add this code to the competitive bidding program as soon as practicable. CMS stated it planned to initially include noninvasive ventilators in Round 2021 of the program but removed the category from that round due to the COVID-19 pandemic. CMS said it will consider including noninvasive ventilators in the program in the future.
Updated Corporate Integrity Agreement Documents
On September 18, the OIG published information on a new Corporate Integrity Agreement with Kelly, William M., M.D., Inc. and Omega Imaging, Inc. of Palm Desert, CA.
Comment Request: Transcatheter Valve Therapy (TVT) Registry; Part D Coordination of Benefits Data; more
On September 18, CMS published a Comment Request in the Federal Register regarding the following information collections:
- Transcatheter Valve Therapy (TVT) Registry
- Mandatory Insurer Reporting Requirements of Section 111 of the Medicare, Medicaid, and SCHIP Act of 2007
- Part D Coordination of Benefits Data
- State Collection and Reporting of Dental Provider and Benefit Package Information on the Insure Kids Now! Website and Hotline
Comments on the information collections are due by November 17.
FY 2021 Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital (LTCH) PPS Changes
On September 18, CMS published Medicare Claims Processing Transmittal 10360 regarding implementation of the FY 2021 IPPS and LTCH PPS updates. This includes DRG changes, NTAP changes, updates to the PSF for wage index changes, and more.
Effective date: October 1, 2020
Implementation date: October 5, 2020
Completion of Removal/Moving of Instructions from Chapter 15 of Pub. 100-08 to Chapter 10 of Pub. 100-08
On September 18, CMS published Medicare Program Integrity Transmittal 10355 regarding the removal of manual instructions in Chapter 15and movement of the instructions to Chapter 10.
Effective date: November 19, 2020
Implementation date: November 19, 2020
Update to the Medicare Claims Processing Manual
On September 18, CMS published Medicare Claims Processing Transmittal 10356 regarding updates to the list of nonfacility POS codes in Chapter 12, Section 20.4.2 to reflect previous updates found in Chapter 26, Section 10.5 which include the non-residential opioid treatment facility (POS code 58) setting. The transmittal also updates the MPFSDB file layout in Chapter 23 to show the procedure code series that are not included on the MPFSDB.
CMS published MLN Matters 11958 on the same date to accompany the transmittal.
Effective date: October 19, 2020
Implementation date: October 19, 2020
Update to the Internet Only Manual (IOM) Pub. 100-04, Chapter 9, Sections 70.7 and 70.8
On September 18, CMS published Medicare Claims Processing Transmittal 10357 regarding updates to add sections on Virtual Communication Services and General Care Management Services – Chronic Care and Psychiatric Collaborative Care Model (CoCM) Services to the manual.
Effective date: October 19, 2020
Implementation date: October 19, 2020