This week in Medicare updates—9/25/2019

September 25, 2019
Medicare Insider

Medicare Incorrectly Paid Providers for Emergency Ambulance Transports from Hospitals to Skilled Nursing Facilities (SNF)

On September 16, the OIG published a Review of whether Medicare payments to providers for emergency ambulance transports from hospitals to SNFs with dates of service from CYs 2015 through 2017 complied with federal requirements. The OIG found providers incorrectly billed all 99 sampled claim lines for these transports, and Medicare contractors made incorrect payments for 86 of those claim lines, totaling $9,563 in incorrect payments. The OIG determined that CMS oversight was not sufficient during the audit period to adequately identify incorrect claim line billing for emergency ambulance transports from hospitals to SNFs. The OIG recommends that CMS develop a fraud prevention model specific to emergency ambulance transports from hospitals to SNFs. CMS concurred with the OIG’s recommendation. 


Extension of Prior Authorization for Repetitive Scheduled Non-Emergent Ambulance Transports

On September 16, CMS published a Notice in the Federal Register to announce a one-year extension of the Medicare Prior Authorization Model for Repetitive Scheduled Non-Emergent Ambulance Transport. This extension applies to Delaware, Maryland, New Jersey, North Carolina, Pennsylvania, South Carolina, Virginia, and West Virginia. 

Dates: This extension begins on December 2, 2019, and ends on December 1, 2020.


Comment Request: Medicare Participation Agreement for Physicians and Suppliers

On September 17, CMS published a Comment Request in the Federal Register regarding the submission for OMB review of an information collection titled, “Medicare Participation Agreement for Physicians and Suppliers.” Comments are due to the OMB desk officer by October 17, 2019.


Updated Civil Monetary Penalties and Affirmative Exclusions

On September 18, the OIG published an updated List of Civil Monetary Penalties and Affirmative Exclusions, including the following:

  • On August 22, American Clinical Solutions, LLC, of Boca Raton, Florida, reached a $61,546.31 settlement agreement with the OIG to resolve allegations that it submitted claims to Medicare for specimen validity testing, a noncovered service. 


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

On September 19, CMS published One-Time Notification Transmittal 2362, which rescinds and replaces Transmittal 2348, dated August 9, 2019, to add a revised spreadsheet for NCD110.23, requirement 3; add FISS responsibility and new verbiage to NCD150.3, requirement 4, and associated spreadsheet; and add revised verbiage to NCD110.21, requirement 11. The original transmittal was issued regarding a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. 

On August 12, CMS published MLN Matters 11392 to accompany the transmittal. 

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

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


Revisions to Medicare State Operations Manual (SOM) Chapter 2

On September 20, CMS published State Operations Provider Certification Transmittal 193 regarding revisions in Chapter 2 of the SOM to clarify the process for critical access hospitals (CAH) adding a provider-based location. This includes information about submitting documentation of distance requirement compliance with a provider-enrollment application and actions that would occur should the provider-based location not meet CAH distance requirements.

Effective date: September 20, 2019

Implementation date: September 20, 2019