This week in Medicare updates—9/9/2020

COVID University Lab Testing FAQs

On August 31, CMS published FAQs regarding SARS-CoV-2 surveillance testing. The FAQ addresses whether a facility needs a CLIA certificate if it is performing pooled testing with non-patient-specific reporting, whether a university should notify a person to seek testing in a CLIA lab if conducting surveillance testing by next-generation sequencing, and how a university lab can become CLIA certified. 

 

Point of Care Antigen Testing FAQ 

On August 31, CMS published an FAQ regarding point of care antigen testing. The FAQ addresses CMS’ current policy on labs performing antigen tests authorized by the FDA under an EUA which are used for asymptomatic individuals at the point of care or in patient care settings operating under a CLIA Certificate of Waiver.

 

FY 2021 IPPS Final Rule

On September 2, CMS published a draft copy of the FY 2021 Inpatient Prospective Payment System (IPPS) Final Rule, which is scheduled to be published in the Federal Register on September 18. The rule is significantly later than usual, as CMS waived the 60-day delay in effective date this year due to the COVID-19 PHE. CMS projects an increase in overall IPPS payments of approximately 2.9% for 2021. Finalized policies include:

• Creating a new MS-DRG specifically for CAR T-Cell therapies.
• Requiring hospitals to report the median payer-specific negotiated charges for Medicare Advantage organizations on the Medicare cost report for cost reporting periods ending on or after January 1, 2021. CMS will use this data beginning in FY 2024 to use a new market-based methodology to set the MS-DRG relative weights.
• Approving 24 technologies for new technology add-on payments in FY 2021, including two technologies under the alternative pathway for new medical devices and conditional approval of one technology designated as a Qualified Infectious Disease Product (QIDP) which has not yet received FDA approval. 
• Making changes related to closing teaching hospitals and closing residency programs to expand the definition of who is considered a displaced resident and to help provide greater flexibility for residents to transfer while hospital operations or residency programs are winding down.
• Finalizing several policies governing what can be reported as Medicare bad debt. 

CMS published a Fact Sheet and Press Release on the rule on the same date. 

Effective date: October 1, 2020

Applicability date: The amendments at §413.89(b)(1)(i), (c)(1), (e)(2)(i)(A)(2) are applicable to cost reporting periods before October 1, 2020. The amendments at §413.89(e)(2)(i)(A)(1), (4) through (6), (i)(B), (iii), and (f) are applicable to cost reporting periods before, on, and after October 1, 2020. The amendments at §413.89(b)(1)(ii), (c)(2), (e)(2)(i)(A)(3) and (e)(2)(ii) are applicable to cost reporting periods beginning on or after October 1, 2020.

 

CMS Generally Met Requirements for the DMEPOS Competitive Bidding Program Round 1 Recompete

On September 2, the OIG published a Review of whether CMS selected DMEPOS suppliers, calculated single-payment amounts (SPA), and monitored suppliers for Round 1 Recompete in accordance with program procedures and federal requirements. The OIG determined that CMS met these standards for 219 of the 225 winning suppliers associated with the sampled SPAs. However, CMS awarded contracts to five suppliers in a manner that did not meet financial statement requirements and to one supplier that did not have the applicable state license. CMS also did not monitor suppliers in accordance with requirements for another seven suppliers for the first six months of 2014. The OIG estimates that CMS paid suppliers $24,054 more than they would have received without any errors. 

The OIG recommends CMS take specific actions described in the report to ensure suppliers meet financial documentation requirements and obtain and maintain required licenses. CMS concurred with the recommendations and said it is working to establish a system that would help continuously monitor DMEPOS suppliers to ensure they maintain an active license. 

 

Medicare Hospital Provider Compliance Audit: Flagstaff Medical Center

On September 3, the OIG published a Review of whether Flagstaff Medical Center complied with Medicare requirements for billing inpatient and outpatient services within certain risk areas identified by prior OIG audits. The OIG determined that Flagstaff complied with Medicare requirements for 97 of the 100 claims reviewed. However, three inpatient claims did not fully comply with Medicare criteria for inpatient status and did not have the documented medical necessity to meet inpatient requirements. The OIG estimated that this resulted in overpayments of at least $79,216 for the audit period. 

The OIG recommends Flagstaff refund the Medicare contract for the overpayments, exercise reasonable diligence to identify, report, and return similar overpayments, and strengthen controls to ensure full compliance.

 

FAQs: Application of OIG’s Administrative Enforcement Authorities to Arrangements Directly Connected to the COVID-19 Public Health Emergency

On September 3, the OIG updated an FAQ regarding changes to enforcement pertaining to arrangements that are directly connected to COVID-19. The new FAQs pertain to a federally qualified health center receiving a COVID relief grant from a private foundation which designated the funds for emergency cash assistance for financially needy individuals and a home health agency furnishing free blood draws. 

 

Update to the Model Admission Questions for Providers to Ask Medicare Beneficiaries

On September 4, CMS published Medicare Secondary Payer Transmittal 10342 regarding modifications to language in the manual to streamline the model admission questions for providers to ask Medicare beneficiaries upon admission to determine whether Medicare is a primary or secondary payer. CMS recently re-reviewed the current list of Medicare questions and decided to update them based on national system changes, provider outreach, and CMS provider training from the past several years. 

CMS published MLN Matters 11945 on the same date to accompany the transmittal. 

Effective date: December 7, 2020

Implementation date: December 7, 2020

 

Update to the Internet Only Manual Pub. 100-04, Chapter 32, Section 40.2.1 and 40.2.4

On September 4, CMS published Medicare Claims Processing Transmittal 10343 regarding changes to the manual to incorporate HCPCS code C1820 into a couple sections based on its inclusion for coverage under NCD 230.18 as effective January 1, 2020. 

Effective date: October 6, 2020

Implementation date: October 6, 2020

                  

Internet Only Manual Update to Pub. 100-04, Chapter 16, Section 60.1.2 and Chapter 26, Section 10.4, Item 19

On September 4, CMS published Medicare Claims Processing Transmittal 10341 regarding the removal of references to EKG services from Chapter 16, Section 60.1.2 and Chapter 26, Section 10.4, Item 19. This change clarifies existing content and does not consist of any policy, processing, or system changes. 

CMS published MLN Matters 11935 on the same date to accompany the transmittal. 

Effective date: October 6, 2020

Implementation date: October 6, 2020