This week in Medicare updates – 1/17/18
HIGLAS Enhancement Required for Implementation of Overpayment based Denials
On January 4, CMS published One-Time Notification Transmittal 1998, which rescinds and replaces Transmittal 1912, dated September 1, 2017, to revise three business requirements and remove two other business requirements. The original transmittal lays out the requirements that are specific to HIGLAS for implementation of overpayment based denials.
Effective date: April 1, 2018
Implementation dates: April 2, 2018
Enhancement to the Recovery Audit Contractor (RAC) Mass Adjustment Input File
On January 5, CMS published One-Time Notification Transmittal 1997 regarding enhancements to the RAC mass adjustment/reporting process in the ViPS Medicare System to reflect whether the RAC adjustment was conducted on an automated or complex basis.
Effective date: July 1, 2018
Implementation date: July 2, 2018
Texting of Patient Information among Healthcare Providers
On January 5, CMS published revisions for a Memorandum, originally published December 28, 2017, to state survey agency directors regarding the agency’s policy on texting of patient information among healthcare providers. The revisions clarify that providers affected by the policy are hospitals and critical access hospitals (CAH). The memorandum notes that texting patient information among members of the healthcare team is permissible if it is done through a secure platform, but texting of patient orders is prohibited regardless of platform. The memorandum also notes that the preferred method of order entry is via Computerized Provider Order Entry (CPOE).
Effective date: Immediately. This policy should be communicated with all survey and certification staff, their managers, and the state/regional office training coordinators within 30 days of the memorandum.
New Waived Tests
On January 5, CMS published Medicare Claims Processing Transmittal 3945, which informs contractors of four newly added Clinical Laboratory Improvement Amendments (CLIA) waived complexity tests. The CPT codes, effective dates, and descriptions for the latest approved waived tests include:
- 83516QW, October 2, 2017, Quidel Corporation, InflammaDry
- 87809QW, October 3, 2017, Quidel, AdenoPlus Test {Tear Fluid}
- 82274QW, G0328QW, October 13, 2017, Enterix Inc. InSure One - One Day Fecal Immunochemical Test
- 85025QW, November 6, 2017, Sysmex XW-100
CMS published MLN Matters 10418 on the same date to accompany the transmittal.
Effective date: April 1, 2018
Implementation date: April 2, 2018
Ensuring Correct Processing of Home Health Disaster Related Claims and Claims for Denial
On January 5, CMS published Medicare Claims Processing Transmittal 3948 to revise the edit that matches claims and assessments, creating a bypass when condition code DR is reported on the claim. The transmittal also notifies contractors of a new edit in Medicare systems to ensure condition code 21 will only be reported on home health claims with Type of Bill 0230.
CMS issued MLN Matters 10372 on the same date to accompany the transmittal.
Effective date: July 1, 2017
Implementation date: July 2, 2018
Updated Corporate Integrity Agreement Documents
On January 8, the OIG published information on a closed Corporate Integrity Agreements with the following organization:
- Parkridge Medical Center of Chattanooga, TN
Medicare Diabetes Prevention Program (MDPP) Enrollment Process
On January 8, CMS published Medicare Program Integrity Transmittal 765 to outline the process by which MDPP Suppliers enroll in Medicare. The transmittal also details how to screen MDPP suppliers and coaches whose information will be submitted on the new MDPP enrollment applications.
Effective date: January 1, 2018
Implementation date: January 19, 2018
Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Medicare Benefit Policy Manual Chapter 13 Update
On January 9, CMS published Medicare Benefit Policy Transmittal 239, which rescinds and replaces Transmittal 238, dated November 17, 2017, to change the effective and implementation dates. The original transmittal clarifies payment and other policy information in Chapter 13 (RHC and FQHC Services) of the Medicare Benefit Policy Manual.
On January 10, CMS published a revised version of MLN Matters 10350 with updated dates to accompany the revisions in the transmittal.
Effective date: January 22, 2018
Implementation date: January 22, 2018
Comment Request: Laboratory Personnel Report and Supporting Regulations; Verification of Clinic Data-Rural Health Clinic Form and Supporting Regulations
On January 9, CMS published a Comment Request in the Federal Register to seek comments on the following information collections:
- Laboratory Personnel Report (CLIA) and Supporting Regulations
- Verification of Clinic Data--Rural Health Clinic Form and Supporting Regulations
Comments are due by March 12.
Updated Civil Monetary Penalties and Affirmative Exclusions
On January 9, the OIG published an updated List of Civil Monetary Penalties and Affirmative Exclusion agreements reached in December, including:
- Phoebe Putney Memorial Hospital (Phoebe Putney), of Albany, Georgia, reached a $50,000 settlement agreement with the OIG on December 26, 2017, to resolve allegations that Phoebe Putney violated the Emergency Medical Treatment and Labor Act by failing to accept an appropriate transfer of a man with a subdural hematoma for neurological services when the facility had both the capabilities and capacity to treat the patient.
- The Female Pelvic Medicine Institute of Virginia, P.C., and Nathan Guerette, M.D., of Richmond and North Chesterfield, Virginia, reached a $1,401,344 settlement agreement and a 3-year integrity agreement with OIG on December 29, 2017, to resolve allegations of submitting claims to federal healthcare programs for items or services that he knew or should have known were not provided as claimed or were false/fraudulent.
CMS Announces New Payment Model to Improve Quality, Coordination, and Cost-Effectiveness for both Inpatient and Outpatient Care
On January 9, CMS published a Press Release announcing the launch of a new bundled payment model called Bundled Payments for Care Improvement Advanced (BPCI Advanced). BPCI Advanced is modeled after the Innovation Center’s previous bundled payment model, but this new model includes outpatient episodes in addition to the previously existing inpatient episodes. BPCI Advanced will qualify as an Advanced Alternative Payment Model under the Quality Payment Program (QPP). The Model Performance Period for BPCI Advanced starts October 1, 2018 and runs through December 31,2023.
On January 10, CMS issued a Fact Sheet providing an overview of the model, key dates, and implementation information.
Implementation of the Transitional Drug Add-On Payment Adjustment
On January 10, CMS published One-Time Notification Transmittal 1999, which rescinds and replaces Transmittal 1889, dated August 4, 2017, to provide more descriptive examples in the policy section for Parsabiv and Sensipar. The original transmittal was published regarding the implementation of the Transitional Drug Add-on Payment Adjustment.
Effective date: January 1, 2018
Implementation dates: January 2, 2018
Proposed Decision Memo for Magnetic Resonance Imaging (MRI)
On January 11, CMS published a Proposed Decision Memo regarding changes to a national coverage determination (NCD) to expand Medicare coverage of MRIs for Medicare beneficiaries with an implanted pacemaker, implantable cardioverter defibrillator, cardiac resynchronization therapy pacemaker, or cardiac resynchronization therapy defibrillator. The proposed changes would apply to section 220.2(B)(3) of the NCD Manual.
CMS is seeking comments on the proposed decision during a 30-day comment period beginning on January 11.
Update to Provider Reimbursement Manual Part 1, Chapter 14, Reasonable Cost of Therapy and Other Services Furnished by Outside Suppliers
On January 12, CMS published Medicare Provider Reimbursement Manual Transmittal 477 to clarify and update material from Chapter 14 (Reasonable Cost of Therapy and Other Services Furnished by Outside Suppliers) of the manual.
Implementation date: January 12, 2018
Update to Provider Reimbursement Manual Part 1, Chapter 9, Compensation of Owners
On January 12, CMS published Medicare Provider Reimbursement Manual Transmittal 476 to update the inflation factors in Chapter 9 (Compensation of Owners).
Implementation date: January 12, 2018
HCPCS Codes Subject To and Excluded From Clinical Laboratory Improvement Amendments (CLIA) Edits
On January 12, CMS published Medicare Claims Processing Transmittal 3949 to inform contractors about the new HCPCS codes for 2018 that are subject to and excluded from CLIA edits.
Effective date: January 1, 2018
Implementation date: April 2, 2018
2018 Durable Medical Equipment Prosthetics, Orthotics, and Supplies HCPCS Code Jurisdiction List
On January 12, CMS published Medicare Claims Processing Transmittal 3950 to provide a spreadsheet with an updated list of HCPCS codes for Durable Medical Equipment MACs and Part B Macs jurisdictions which reflects the codes that were added or deleted for 2018.
Effective date: January 1, 2018
Implementation date: February 13, 2018
Notice of New Interest Rate for Medicare Overpayments and Underpayments - 2nd Qtr Notification for FY 2018
On January 12, CMS published Medicare Financial Management Transmittal 297 to provide notification of the new interest rate for the second quarter of FY 2018. The Department of the Treasury notified the Department of Health and Human Services that the private consumer rate has been changed to 10.625%.
Effective date: January 19, 2018
Implementation date: January 19, 2018