This week in Medicare updates – 1/24/18

January 24, 2018
Medicare Insider

Clarification of the Accrediting Organization’s Role when a Provider or Supplier’s Deemed Status has been Temporarily Removed

On January 12, CMS published a Memorandum to state survey agency directors clarifying the role of an accrediting organization (AO) when a provider or supplier’s deemed status has been temporarily removed. The memo states that CMS may remove deemed status when a state agency or federal survey team identifies certain types of non-compliance during either a representative sample or substantial allegation validation survey. The regional office is then responsible for telling the provider or supplier in writing that its deemed status has been removed and it is under state agency jurisdiction. The temporary removal of deemed status is an acceptable reason for delayed conduct of a triennial survey, and once status is restored, the AO should delay the survey for a reasonable period of time for integrity purposes.  

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 this memorandum.


2018 Value Modifier Results

On January 12, CMS published a Fact Sheet regarding the results of the 2018 Value Modifier and the adjustment factor that will be applied to clinicians receiving an upward payment adjustment. Over 20,000 clinicians will receive between 6.6% to 19.9% more on their Medicare physician fee schedule payments as a result of their high performance on quality and cost measures in 2016. This marks the last year of the Value Modifier, as the Merit-based Incentive Payment System under the Quality Payment Program will replace the Value Modifier beginning in 2019.


Home Health Agency (HHA) Survey Protocol - State Operations Manual (SOM) Appendix B Revised

On January 16, CMS published a revised Memorandum to state survey agency directors regarding revisions to Appendix B of the SOM following new Conditions of Participation (CoPs) for HHA which went into effect January 13. The memorandum details revisions to selected sections of the HHA survey process, and it contains two attachments containing new Aspen tags and revisions for Level I and Level II standards based on the new CoPs.

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 this memorandum.


Medicare Advantage Encounter Data Shows Promise for Program Oversight, But Improvements Are Needed

On January 16, the OIG published a Report regarding CMS oversight of errors in Medicare Advantage encounter data. The OIG found that only 5% of records in the review would contain a potential error. It also noted that, because CMS does not require Medicare Advantage Organizations (MAOs) to submit identifiers for ordering or referring providers and only requires identifiers for rendering providers in certain circumstances, these identifiers were frequently missing from encounter data and therefore limits the use of this data for vital program oversight and enforcement activities.

OIG recommends CMS:

  • Address potential errors in the MA encounter data
  • Provide targeted oversight of MAOs that submitted a higher percentage of records with potential errors
  • Ensure that billing provider identifiers are active and valid on all records
  • Require MAOs to submit ordering and referring provider identifiers/ensure submission of rendering provider identifiers on applicable records
  • Track how MAOs respond to edits that reject data
  • Establish and monitor performance thresholds related to MAOs submission of records with complete, valid data  


Update to OIG Work Plan

On January 16, the OIG updated its Work Plan to include the following reviews:


Medicare Quarterly Provider Compliance Newsletter January 2018

On January 18, CMS posted the Medicare Quarterly Provider Compliance Newsletter for January 2018. This edition of the newsletter provides education on how to avoid compliance issues related to the following:

  • Advance care planning
  • Proper use of modifier -59


ICD-10 and Other Coding Revisions to National Coverage Determinations (NCDs)

On January 18, CMS published One-Time Notification Transmittal 2005, which rescinds and replaces Transmittal 1975, dated November 9, 2017, to revise the MAC implementation date, several business requirements, and attachments. The original transmittal constituted a maintenance update of ICD-10 conversions and other coding updates specific to NCDs, including adding and deleting certain diagnosis codes from NCDs.

Effective date: April 1, 2018 - unless otherwise noted in requirements

Implementation date: January 29, 2018 for local MAC edits; April 2, 2018 - for shared system edits (except FISS exception for requirements 1, 8, 12, 19, 21); July 2, 2018 - FISS only for requirements 1, 8, 12, 19, 21


Internet Only Manual (IOM) Update to Pub. 100-02, Chapter 11 - End Stage Renal Disease (ESRD), Section 100

On January 19, CMS published Medicare Benefit Policy Transmittal 240 regarding an update to Section 100 of Chapter 11 of the Medicare Benefit Policy Manual. This update applies to payment for renal dialysis services furnished to individuals with acute kidney injury.

Effective date: January 1, 2017

Implementation date: February 20, 2018